Objective To investigate the efficacy and safety of artificial liver support therapy with an Evanure-4A selective membrane plasma separator and its influence on platelet count in the treatment of patients with acute-on-chronic liver failure(ACLF)patients with different platelet counts.Methods A total of 302 patients with ACLF who were hospitalized in Department of Hepatology,Chengdu Public Health Clinical Medical Center,from January 2021 to May 2023,were enrolled,and according to the platelet count(PLT),they were divided into group A(25×109/L—50×109/L)with 101 patients,group B(51×109/L—80×109/L)with 98 patients,and group C(81×109/L—100×109/L)with 103 patients.In addition to medical treatment,all patients received different modes of artificial liver support therapy based on their conditions,including plasma perfusion combined with plasma exchange,double plasma molecular adsorption combined with plasma exchange,and bilirubin system adsorption combined with plasma exchange.The paired t-test was used for comparison of continuous data before and after treatment in each group;an analysis of variance was used for comparison between multiple groups,and the SNK-q test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between multiple groups.Results Of all 302 patients,268(88.74%)achieved varying degrees of improvement in clinical symptoms after artificial liver support therapy.After treatment,all three groups had varying degrees of reductions in alanine aminotransferase(t=14.755,21.614,and 15.965,all P＜0.001),aspartate aminotransferase(t=11.491,19.301,and 13.919,all P＜0.001),total bilirubin(t=19.182,17.486,and 21.75,all P＜0.001),and international normalized ratio(INR)(t=3.497,3.327,and 4.358,all P＜0.05).After artificial liver support therapy with an Evanure-4A selective membrane plasma separator,PLT in group A decreased from(37.73±6.27)×109/L before treatment to(36.59±7.96)×109/L after treatment,PLT in group B decreased from(66.97±7.64)×109/L before treatment to(62.59±7.37)×109/L after treatment,and PLT in group C decreased from(93.82±5.38)×109/L before treatment to(85.99±12.49)×109/L after treatment;groups B and C had significant reductions in PLT after treatment(t=12.993 and 8.240,both P＜0.001),but there was no significant difference in group A(P＞0.05).There was no significant difference in the incidence rate of adverse reactions during artificial liver support therapy between the three groups(P＞0.05).Conclusion Artificial liver support therapy can improve liver function and INR in patients with ACLF.The use of Evaure-4A selective membrane plasma separator during artificial liver support therapy has little influence on platelets,and it is safe in the treatment of ACLF patients with a significantly lower level of platelets.

Purpose: To determine the risk factors predicting upper urinary tract (UUT) damage using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with myelodysplasia. Methods: Six hundred thirty-seven patients with myelodysplasia were evaluated at our center from January 2008 to November 2019. Clinical data, ultrasonography, magnetic resonance urography, and video-urodynamics (VUDS) parameters were collected. Univariate and multivariate analyses were used to determine the risk factors predicting UUT damage. Results: Three hundred eighty-three males and 254 females were included. The average course of lower urinary tract symptoms (LUTS) was 14.08±7.07 years (range, 3–31 years). The urodynamic diagnoses of all patients were as follows: detrusor overactivity, 26.8%; detrusor underactivity, 6.44%; and acontractile detrusor, 66.72%. UUT damage was determined in 66.56% of the patients. Of the patients, 28.73 % had vesicoureteral reflux (VUR) during filling (bilateral, n=50; unilateral, n=133) on fluoroscopy during VUDS testing. Two hundred thirty-four patients had UUTD (bilateral, n=203; unilateral, n=31). The occurrence of hydronephrosis based on ultrasonography was closely related to ipsilateral VUR (P<0.05). Absent of bladder sensation, long-term course of LUTS, decreased maximum cystometric capacity (MCC) and bladder compliance (BC), and increased postvoid residual urine (PVR) were shown to be independent risk factors in logistic regression analysis. Conclusions This retrospective study using UUTD and AUTD systems indicated that patients with myelodysplasia have a high incidence of UUT damage. Absence of bladder sensation, long-term course of LUTS, decreased MCC and BC, and increased PVR were independent risk factors predicting UUT damage.

Purpose: The present study determined the effects of saphenous nerve stimulation (SNS) at different stimulation frequencies on bladder reflex and explored a possible action mechanism of tibial nerve stimulation (TNS) on bladder activity in cats. Methods: Two bipolar nerve cuff electrodes were implanted on the saphenous nerve and the contralateral tibial nerve in 13 cats, respectively. Multiple cystometrograms were obtained to determine the effects of single SNS at different frequencies and that of combined SNS and TNS on the micturition reflex by infusing normal saline. Results: SNS at 1 Hz significantly reduced the bladder capacity (BC) to 59.8%±7.7% and 59.3%±5.8% of the control level at the intensity threshold (T) and 2T, respectively (P<0.05), while that at 20 Hz significantly increased the BC to 130.6%±4.2% of the control level at 6T (P<0.05). The TNS and SNS at 20 Hz did not significantly change the BCs at 1T (P>0.05), while combined stimulation at 1T significantly increased the BC to 122.7%±1.9% of the control level and induced an inhibitory effect which was similar to that TNS at 2T. Conclusions The current study revealed that SNS reduced and increased BC depending on different stimulation frequencies. The combined SNS and TNS maximized the clinical efficacy at a low intensity. Also, SNS may be a potential therapeutic mechanism of TNS.

Objective:To explore the influence of peer support education on psychosocial adaptation and psychological distress of breast cancer patients.Methods:Using non-simultaneous experimental research methods, a total of 51 breast cancer patients admitted to the department of breast surgery, the First Affiliated Hospital of Nanchang University from June to August 2019 were selected as the control group, and 53 breast cancer patients admitted from September to December 2019 were selected as the intervention group. The control group received routine education, while the intervention group received peer education on the basis of routine education. After 4 months of intervention, the differences of psychosocial adaptation and psychological pain were compared between the two groups.Results:After 4 months of intervention, 49 cases in the control group and 51 cases in the intervention group completed the study. In the psychosocial adaptation scale, the scores of anxiety/depression, self-esteem, self-acceptance, self-control and self-efficacy belonging in the intervention group were (29.43±2.83), (32.08±3.07), (28.10±2.62), (28.08±3.27), (31.53±3.73) points, which were higher than (27.67±3.96), (30.14±2.54), (25.94±2.91), (25.16±2.95), (30.02±2.70) points in the control group after the intervention, and difference statistically significant ( t values were -4.680 to -2.312, P<0.05). The score of psychological pain in the intervention group (2.37±1.15) points was significantly lower than that in the control group (3.57±0.98) points, and difference was statistically significant ( t value was 4.867, P<0.05). The number of patients with mild and moderate psychological pain in the intervention group was 51 cases accounting for 100% (51/51), which was higher than 48 cases accounting for 98% (48/49) in the control group, and difference was statistically significant ( χ2 value was 12.272, P<0.05). Conclusions:Peer education can effectively improve the psychosocial adaptability of breast cancer patients and reduce their pain level.

Purpose: The present study determined the effects of saphenous nerve stimulation (SNS) at different stimulation frequencies on bladder reflex and explored a possible action mechanism of tibial nerve stimulation (TNS) on bladder activity in cats. Methods: Two bipolar nerve cuff electrodes were implanted on the saphenous nerve and the contralateral tibial nerve in 13 cats, respectively. Multiple cystometrograms were obtained to determine the effects of single SNS at different frequencies and that of combined SNS and TNS on the micturition reflex by infusing normal saline. Results: SNS at 1 Hz significantly reduced the bladder capacity (BC) to 59.8%±7.7% and 59.3%±5.8% of the control level at the intensity threshold (T) and 2T, respectively (P<0.05), while that at 20 Hz significantly increased the BC to 130.6%±4.2% of the control level at 6T (P<0.05). The TNS and SNS at 20 Hz did not significantly change the BCs at 1T (P>0.05), while combined stimulation at 1T significantly increased the BC to 122.7%±1.9% of the control level and induced an inhibitory effect which was similar to that TNS at 2T. Conclusions The current study revealed that SNS reduced and increased BC depending on different stimulation frequencies. The combined SNS and TNS maximized the clinical efficacy at a low intensity. Also, SNS may be a potential therapeutic mechanism of TNS.

Purpose: To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury (SCI). Methods: This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic SCI and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings. Results: Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1–9), thoracic (T10–12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58 of 92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation (BS), bladder capacity during urine leakage was far higher in those with BS. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury. Conclusions This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, BS is important for urinary control in patients with traumatic SCI.

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P<0.05). During AA infusion, SNM at 64 μsec, 204 μsec, and 624 μsec increased the bladder capacity to 126.1%±6.9%, 129.5%±7.3%, and 140.1%±7.6% of the AA control level (P<0.05). No significant differences were found among the results obtained using pulse widths of 64 μsec, 204 μsec, and 624 μsec (P>0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P<0.05). No significant differences were found among the T visual for pulse widths of 204 μsec and 624 μsec (P>0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.
Acetic Acid ; Humans ; Reflex ; Spinal Nerves ; Swine ; Tail ; Urinary Bladder ; Urinary Bladder, Overactive ; Urination

PURPOSE: We investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM (pulse width, 210 µsec) at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex. RESULTS: AA-induced bladder overactivity significantly reduced the bladder capacity (BC) to 34.4%±4.7% of the NS control level (354.4±35.9 mL) (P<0.05). During AA infusion, SNM at 5 Hz did not significantly change the BC (48.1%±6.9% of the NS control level) (P>0.05), but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P<0.05), respectively. No significant differences were found among the results obtained using frequencies of 15, 30, and 50 Hz (P>0.05). CONCLUSIONS: This study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.
Acetic Acid ; Reflex ; Spinal Nerves ; Swine* ; Tail ; Urinary Bladder* ; Urinary Bladder, Overactive ; Urination

Objective Objective To evaluate the effects of a new type of tibial nerve microstimulator on the micturition reflex in cats.Methods From March to May in 2017,the implantable wireless driver micro-stimulator was implanted around the tibial nerve in 9 α-chloralose anesthetized domestic shorthairs cats (2.5-3.5 kg,6-12 months old).The stimulator was placed near the neurovascular bundle parallel to the tibial nerve and its cathode perpendicular to the cushion.The intensity which can induce toe movement was defined as threshold (T).The ureters were isolated via an abdominal incision.The ureters were cut and drained externally.The bladder was inserted via a double lumen catheter through the urethra.The catheter was then secured by a ligature around the urethra.One lumen of the catheter was used to infuse the bladder with either 0.9％ normal saline (NS) or 0.25％ AA at a rate of 1 to 2 ml/min after connecting to a pump.The other lumen was connected to a pressure transducer to measure the bladder pressure.The bladder capacity was used to test the inhibitory effect of the stimulator.After the appearance of the first large-amplitude (＞ 30 cmH2O) bladder contraction,the bladder infusion was stopped.First,after emptying the bladder,2 or 3 cystometrograms with NS were performed without stimulation to obtain the control bladder capacity.After the bladder was stabilized,TNS (6 Hz,1-2 T) was applied during 2 sequential cystometrograms.Second,after emptying the bladder,0.25 ％ AA was infused into the bladder to irritate and induce bladder overactivity.After the bladder stabilized,TNS (6 Hz,1-2 T) was applied again during 2-3 sequential cystometrograms.If bladder capacity increased significantly,the stimulationhad an inhibitory effect on the micturition reflex.Results During normal saline infusion,the bladder baseline was (17.03 ± 4.10) ml.TNS at 1T did not change the bladder capacity [(18.56 ±0.81)ml] (P ＞0.05).TNS at 2T significantly increased the bladder capacity [(25.05 ± 1.19) ml] (P ＜ 0.05).Compared to normal saline infusion,bladder overactivity was irritated by the intravesical infusion of 0.25％ acetic acid,which significantly reduced the bladder capacity [(9.34 ± 0.75) ml] (P ＜ 0.05).Compared to acetic acid infusion,TNS at 1T did not change the bladder capacity [(11.32 ± 0.82) ml] (P ＞ 0.05).TNS at 2T significantly increased the bladder capacity [(14.82 ± 1.15) ml] (P ＜ 0.05).Conclusions The implantable wireless driver tibial nerve micro-stimulator appears to be effective in inhibiting the micturition reflex during physiologic and pathologic conditions.The implantable wireless driver tibial nerve microstimulator was excepted to be used to treat overactive bladder (OAB).

Objective To investigate the effects of sevoflurane ( Sevo ) on dendritic development and the expression of collapsin response mediator proteins ( CRMP ) in the hippocampus of developing rats. Methods Twenty-four neonatal Sprague Dawley (SD) rats at postnatal day 7 (P7) were randomly divided into control group or sevoflurane group ( 12 rat pups for each group) .Rats in the control group were exposed to air for 4 h,whereas rats in the sevoflurane group were exposed to 2.8%sevoflurane for 4 h.The hippocam-pus of some rats were collected,and the expressions of CRMP1,CRMP2 and CRMP4 proteins and phospho-rylation of CRMP2 protein at Ser522,Thr514 and Thr555 were detected by Western blot 6h after exposure ( n=6) .The rest rats were housed till P30,the expression of CRMP1,CRMP2 and CRMP4 proteins in the hip-pocampus were detected by Western blot ( n=6) and the morphology changes of dendrites in the dentate gy-rus ( DG) of hippocampal neurons were detected by Golgi-Cox Staining ( n=6) .Results The expression of CRMP1,CRMP2 and CRMP4 proteins of rats at P7 in the sevoflurane group was decreased by 35.0%( P=0.004) ,27.5%( P=0.015) and 12.0%( P=0.003) ,respectively,and the phosphorylation of CRMP2 pro-tein at Ser522 and Thr514 in the sevoflurane group were increased by 68.3%( P<0.01) ,74.5%( P<0.01) , respectively,6 h after exposure compared with control rats.However,the phosphorylation of CRMP2 protein at Thr555 was not significantly changed after sevoflurane exposure.At P30,both total dendrite length ( P=0.001) and the dendrites length at level 2 and 3 ( P=0.033, P<0.01,respectively) were shorter and the dendritic branching at 120,140 and 160 μm rings in Sholl analysis were less ( P=0.009, P=0.028, P=0.048,respectively) for rats in the sevoflurane group,compared with control rats.There were no significant changes at the expressions of CRMP1,CRMP2 and CRMP4 proteins.Conclusion Sevoflurane inhibits the development of dendrites in the hippocampal DG area of developing rats,which may be related to inhibition of CRMP1,CRMP2 and CRMP4 proteins expression and hyperphosphorylation of CRMP2 Ser522 and Thr514.