BACKGROUND:Mechanical factors can affect the angiogenic ability of vascular endothelial cells.How the vessel number affects the hydrodynamic properties of microvessels remains to be clarified. OBJECTIVE:To investigate the influence of vessel number on the hydrodynamics of vascular networks based on computational fluid dynamics. METHODS:Three three-dimensional models of vascular network with different vessel numbers were constructed using the Geometry module of ANSYS 19.0 software,and then the vascular network was meshed to tetrahedral elements in Mesh module.The vascular network was assumed to rigid wall without slip,and the blood was assumed to laminar,viscous,and incompressible Newtonian fluid.Blood density,velocity,and a series of blood viscosity coefficients were also established.The Navier-Stokes equation was used for calculation.Hydrodynamic properties of different parts of vascular network with different vessel numbers were analyzed and compared. RESULTS AND CONCLUSION:The streamline,velocity,and mass flow all had the same trend in the vascular network,that is,the outlet and inlet were higher and the middle junction of vascular network was lower.The more the number of vessels,the thinner the blood flow lines in each part of the vascular network.Also,the velocity,mass flow,and wall shear decreased with the increase of the number of blood vessels.Therefore,the changes in vessel number could influence the hydrodynamic environment in the vascular network.Computational fluid dynamics indicates that the changes in vessel numbers can influence the hydrodynamic properties of blood,and provides a new idea for treating bone hypoperfusion-induced diseases(fracture nonunion,bone defect,osteoporosis,etc.)through tonifying kidney and activating blood circulation based on the coupling between angiogenesis and osteogenesis.

Objective: To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions. Methods: A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year. Results: There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66). Conclusions The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

OBJECTIVETo delineate the phenotypic characteristics of 22q11.2 deletion syndrome and the role of CRKL gene in the pathogenesis of cardiac abnormalities.

METHODSG-banded karyotyping, single nucleotide polymorphism (SNP) array and fluorescence in situ hybridization (FISH) were performed on a fetus with tetralogy of Fallot detected by ultrasound. Correlation between the genotype and phenotype was explored after precise mapping of the breakpoints on chromosome 22q11.2. SNP array was also performed on peripheral blood samples from both parents to clarify its origin.

RESULTSThe fetus showed a normal karyotype of 46,XY. SNP array performed on fetal blood sample revealed a 749 kb deletion (chr22: 20 716 876-21 465 659) at 22q11.21, which encompassed the CRKL gene but not TBX1, HIRA, COMT and MAPK1. Precise mapping of the breakpoints suggested that the deleted region has overlapped with that of central 22q11.2 deletion syndrome. SNP array analysis of the parental blood samples suggested that the 22q11.21 deletion has a de novo origin. The presence of 22q11.21 deletion in the fetus was also confirmed by FISH analysis.

CONCLUSIONCentral 22q11.21 deletion probably accounts for the cardiac abnormalities in the fetus, for which the CRKL gene should be considered as an important candidate.

Adaptor Proteins, Signal Transducing ; genetics ; Adult ; Chromosome Deletion ; Chromosomes, Human, Pair 22 ; genetics ; DiGeorge Syndrome ; diagnosis ; embryology ; genetics ; Female ; Fetal Diseases ; diagnosis ; genetics ; Genotype ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Nuclear Proteins ; genetics ; Phenotype ; Pregnancy ; Prenatal Diagnosis

Objective To investigate the association between the RoSCo scoring system and the postopera tive complications of laparoscopic partial nephrectomy.Methods The clinical data of 127 patients with laparoscopic partial nephrectomy in our hospital from 2010 to 2015 were retrospectively analyzed.By studying all patients' preoperative clinical data,we give all the patients the RoSCo score,then divided all the patients into the RoSCo low group (3-4),RoSCo moderate group (5-6),RoSCo high group (7-8).Respectively study the association between the RoSCo score and Clavein score,operative time,intraoperative blood loss,warm ischemia time and length of hospital stay after laparoscopic partial nephrectomy.Results The RoSCo score was associated with postoperative complications of laparoscopic partial nephrectomy (P ＜ 0.05) and was more accurate than the RENAL score alone.There were significant differences in bleeding,warm ischemia time,hospital stay and operation time between the low,middle and high groups of RoSCo (P ＜ 0.05).Conclusion The RoSCo scoring system can be used to assess the complications of laparoscopic partial nephrectomy.

Objective To establish the a staging system based on scoring of ketamine associated urinary dysfunction (KAUD) and evaluate its diagnosis performance and clinical value.Methods A retrospective analysis of 135 admitted KAUD patients from September 2009 to September 2015 was performed.All patients were classified into three stages according to bladder and upper urinary tract impairment, and treated with subsequent strategy.The behavioral modification and pharmacotherapy was performed in stage Ⅰ which image investigation was normal.Hydrodistension and intravesical perfusion was used if pharmacotherapy failed in stage Ⅱ patients who had bladder impairment in image or urodynamics.Augmentation cystoplasty or cystectomy with urinary diversion was optional if aforementioned treatment failed in stage Ⅲ who had upper urinary tract involvement and abnormal renal function.The voided volume, micturition interval, and nocturnal void frequency as recorded in their 3-day bladder diary, PUF, ICPI and ICSI score after treatment in one month, were compared with their baseline data prior to treatment.Ketamine abusing history, renal and liver function, bladder and upper urinary tract changes, urodynamics and radioisotope renography correlation with stages were analyzed.A scoring system was established and the concordance between the clinical staging and model staging of each patient was compared.Receiver operating characteristic curve was employed to testify the sensitivity and specificity.Results There were 39, 80 and 16 patients included in each stage respectively.After subsequent strategy of treatment, voided volume, micturition interval, and nocturnal void frequency, PUF, ICPI and ICSI were improved significantly.Age (P =0.018), ketamine abusing history (P =0.006), eGFR (P =0.001), ALT (P =0.037), γ-GT (P ＜ 0.001), bladder (P =0.013) and ureteral changes (P ＜ 0.001), hydronephrosis (P ＜ 0.001) and radioisotope renography abnormality (P =0.01) were correlated with clinical stages.In total, 107 cases' stages based on scoring were accordant with clinical stages (30, 65 and 12 cases in each stage respectively).AUC of the scoring model ROC was 0.922 on cut point between Ⅰ and Ⅱ stages and AUC of the scoring model ROC was 0.978 on cut point between Ⅱ and Ⅲ stages.Conclusions We presented a scoring staging system of KAUD based on ketamine abusing history, laboratory test results, and imaging findings.It might be helpful to evaluate the progression on bladder and upper urinary tract, and provide a reference for treatment.This staging system based on scoring still needs further validation and improvement.

Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction (KUUTD).Methods Medical records of 103 patients with ketamine-associated urinary dysfunction(KAUD) from Sep.2009 to Jul.2015 were retrospectively reviewed.All the patients were divided into the upper urinary tract dysfunction group(n =39)or the normal group(n =64)according to the diagnostic criteria.Indexes such as general features (age,gender,BMI),drug-abusing characteristics (abusing time,frequency,dose,abstinent period),duration of LUTS,pelvic pain and urgency/frequency symptom score(PUF score),serum parameters (WBC,ALT,AST,γ-GT),bladder diary (daytime inter-void interval,nocturia,average urine volume),urodynamic data (maximum cystometric capacity,post-void residual,maximum urethral closure pressure,maximum and average flow rate,instable contraction,bladder compliance) and imaging manifestations were compared between the two groups.Logistic regression analysis was performed for the evaluation of variables with statistical significance.Results There was significantly difference between the two groups in BMI (t =2.127,P =0.043),drug-abusing frequency (t =2.335,P =0.029),abstinent period (t =3.451,P =0.003),duration of LUTS (t =2.289,P =0.036),PUF score (t =3.030,P =0.004),γ-GT value(t =2.697,P =0.012),MCC(t =5.056,P ＜ 0.001),MUCP(t =3.015,P =0.008),BC (t =8.562,P ＜ 0.001) and imaging findings of bladder contracture (x2 =15.155,P ＜0.001).The multivariate Logistic regression analysis showed that drug-abusing frequency(OR =1.279,P =0.038),abstinent period(OR =0.394,P =0.028),γ-GT value (OR =1.007,P =0.032),MCC (OR =0.775,P =0.011)and BC (OR =0.013,P =0.008)were the key factors of KUUTD.Conclusion Consecutive and frequent drug abuse,combination with chronic obstructive cholangitis,reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse.

Objective To study tirofiban intravenous injection,coronary artery injection of the two different methods in acute ST segment elevation myocardial infarction,the application of emergency PCI.Methods Patients underwent emergency PCI with acute ST segment elevation myocardial infarction as the research subjects,a total of 108 cases,the patients were randomly divided into the observation group and control group,54 patients in each group. In the observation group,the first dose of tirofiban was injected into the coronary artery.The control group was treated by intravenous injection.The results of the two groups were compared.Results Before treatment,TIMI level 2 and level 3 ratio,initial corrected TIMI frame count of the observation group were significantly lower than the control group (χ2 /t =4.32,4.59,5.25,all P <0.05).After treatment,MBG level 2 or level 3 ratio,post -operative corrected TIMI frame count of the observation group were significantly higher than the control group (χ2 /t =4.11,4.85,5.87, all P <0.05).1 h after PCI treatment,the number of cases of ST fully back,the added value of EF,plague index scores of observation group were 53 cases,(8.02 ±6.94)%,(0.41 ±0.28)respectively,which were significantly higher than those of the control group 36 cases,(5.87 ±6.54)%,(0.28 ±0.27)(χ2 /t =5.32,4.32,3.65,all P <0.05).Adverse events of the two groups had no significant difference (χ2 =0.52,P >0.05).Conclusion Compared with intravenous injection,tirofiban in the treatment of acute ST segment elevation myocardial infarction by intracoronary injection can improve the level of myocardial perfusion after PCI operation,promote the recovery of left ventricular function,and has high security.

Objective To compare the clinical effect of ERCP and PTCD metal stent implantation in the treatment of malignant obstructive jaundice.Methods 42 patients who were treated successfully with ERCP biliary metal stent implantation in the treatment of malignant obstructive jaundice were selected as the ERCP group,38 patients who were successfully treated with PTCD biliary metal stent implantation in the treatment of malignant obstructive jaundice,were selected as the PTCD group.The changes of alanine aminotransferase,aspartate aminotransferase,direct bilirubin,total bilirubin content and complications of patients were compared between two groups.Results On the third day of the ERCP group after operation,alanine aminotransferase,aspartate aminotransferase,direct bilirubin,total bilirubin levels were (203.94 ±12.53)U /L,(180.94 ±17.53)U /L,(185.63 ±17.53)μmol/L,(240.41 ± 18.79)μmol/L respectively,those of the PTCD group were (230.63 ±13.95)U /L,(209.19 ±19.74)U /L,(192.52 ± 16.93)μmol/L,(266.83 ±20.73)μmol/L respectively,which were significantly lower than before operation(all P <0.05).The incidence rate of complications of ERCP group was 4.76%,which was significantly lower than 23.68% of the PTCD group(χ2 =6.02,P <0.05).Conclusion ERCP and PTCD biliary metal stent placement in the treatment of malignant obstructive jaundice can effectively relieve the obstruction.The incidence of complications of PTCD is slightly higher in both common complications.

Objective To investigate the prenatal diagnosis and phenotypic assessment strategies for fetal supernumerary marker chromosomes and derivative chromosomes. Methods Five cases of fetal supernumerary marker chromosomes and one case of fetal derivative chromosomes were diagnosed in the First Affiliated Hospital of Sun Yat-Sen University from March 12, 2010 to November 9, 2012 by conventional chromosome banding, fluorescence in situ hybridization (FISH) and spectral karyotyping (SKY). These cases were retrospectively reviewed. Combined with the results of ultrasonography, abnormal phenotypes and pregnancy outcomes were evaluated in these cases. Results All of the five supernumerary marker chromosomes were de novo, in which two were mosaic and the remaining three cases were non-mosaic. Of these five cases, two were type 47, XX+mar and ultrasound indicated abnormal phenotypes. FISH and SKY confirmed that they were derived from chromosome 4 and 22, respectively. The other three cases were marker chromosome with Turner syndrome karyotype (abnormal phenotypes were not found by ultrasound), in which two cases were derived from chromosome Y (by FISH) and one case was identified as ring chromosome X (by FISH and SKY). One de novo derivative chromosome was verified as a product of reciprocal translocation between chromosome 2 and 6 (by FISH and SKY). Induced abortion was performed in all cases between 25 and 32 gestational weeks. Conclusions By combining conventional chromosome banding, FISH and SKY, the origin and content of supernumerary marker chromosomes and derivative chromosomes can be identified. On this basis, clinical phenotype evaluation and genetic counseling may be offered with the ultrasonographic result.

BACKGROUNDOveractive bladder (OAB) is a series of symptoms with high prevalence in elderly people. This study was conducted using the overactive bladder symptom score (OABSS) to evaluate the efficacy of solifenacin succinate for the treatment of OAB.

METHODSThis was a prospective, multicenter, single-arm, 12-week study that enrolled 241 OAB patients. The patients received 5-10 mg/day solifenacin. Changes in OABSS, symptoms from voiding diary, perception of bladder condition (PPBC) score, international prostate symptom score (IPSS) and quality of life (QOL) were evaluated at weeks 0, 4, and 12. The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.

RESULTSAt baseline, the mean OABSS for all patients was 9.41 ± 2.40, and was reduced significantly at week 12 (-3.76 points; 61.21%, P < 0.0001). The OABSS subscore, PPBC score, IPSS, and QOL were also significantly reduced during the study (P < 0.0001). The overall incidence of adverse events was 19.91% (44 cases). The gastrointestinal system was the most commonly affected (11.31%). Around 5.88% of the cases had adverse events related to the genitourinary system. There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.

CONCLUSIONSWe showed that solifenacin was clinically effective for relieving OAB symptoms, considering the balance between efficacy, patients' well-being, and tolerability. OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Muscarinic Antagonists ; therapeutic use ; Prospective Studies ; Quality of Life ; Quinuclidines ; therapeutic use ; Solifenacin Succinate ; Tetrahydroisoquinolines ; therapeutic use ; Treatment Outcome ; Urinary Bladder, Overactive ; drug therapy