Preoperative systemic immune-inflammation index as a significant prognostic factor after TURBT in patients with non-muscle-invasive bladder cancer: A retrospective study based on propensity score matching analysis.

OBJECTIVE: To investigate the association of the preoperative systemic immune-inflammation index (SII) with recurrence-free survival (RFS) after transurethral resection of the bladder tumor (TURBT) of non-muscle-invasive bladder cancer (NMIBC) using propensity score matching (PSM) analysis. METHODS: The clinicopathological characteristics and follow-up data of NMIBC patients were collected retrospectively from two tertiary medical centers. A 1:1 PSM analysis was carried out using the nearest-neighbor method (caliper size: 0.02). Cox regression analysis was used to identify the risk factors associated with RFS. RESULTS: A total of 416 NMIBC patients were included in this study. Before and after matching, patients with increased SII had worse RFS (p < 0.0001 and p = 0.027, respectively). Multivariate Cox analysis identified SII as an independent predictor of RFS before (HR [95% CI]: 1.789 [1.232, 2.599], p = 0.002) and after matching (HR [95% CI]: 1.646 [1.077, 2.515], p = 0.021). In the matched subgroup analysis, an elevated SII had a significant association with postoperative worse RFS in the T1 stage (p = 0.025), primary status (p = 0.049), high-grade (p = 0.0015), and multiple lesions (p = 0.043) subgroups. CONCLUSION: SII could accurately stratify the prognosis of NMIBC patients before and after PSM analysis. An elevated SII was significantly associated with worse RFS in NMIBC patients.

Expression of adenovirus-mediated neurotrophin-3 gene in Schwann cells of sciatic nerve in rats.

OBJECTIVE: To investigate the expression of neurotrophin-3 (NT-3) gene in Schwann cells of rat sciatic nerve introduced by an adenovirus vector in vivo. METHODS: A recombinant adenovirus vector for NT-3 (Ad-NT-3) was propagated in 293 packaging cells and titered with tissue culture infectious dose(50) (TCID(50)). Ad-NT-3 was injected directly into the rat sciatic nerve after transection and immediate repair. Immunohistochemical staining was employed to determine the expression of NT-3 in Schwann cells in rat sciatic nerve and the expressive intensity of the tissue slices of the sciatic nerve was measured with LEICA M550 image analysis system. RESULTS: On the 2nd day after injection of Ad-NT-3, positive stain in the Schwann cells was apparent in the vicinity of anastomosis. NT-3 expression increased significantly on the 7th day (P<0.01) and then decreased 14-28 days after injection (P<0.01). There was no significant difference of NT-3 expression between the 14th and 28th day groups (P<0.05). Compared with the 2nd day group, the 14th and 28th day groups still maintained a relatively high level of NT-3 (P<0.01). Intact and repaired nerves, which were injected with adenovirus encoding LacZ genes (Ad-LacZ) or physiological saline served as controls, showed no NT-3-positive Schwann cells. CONCLUSIONS: An adenovirus vector can be used to induce efficiently the expression of NT-3 gene in Schwann cells of rat peripheral nerves following nerve injury and repair, which suggests that neurotrophic factors can be introduced into Schwann cells with an adenovirus vector to promote peripheral nerve regeneration.

Treatment of limb arterial injuries caused by traffic accidents.

OBJECTIVE: To analyze the features, diagnosis and treatment of limb arterial injuries caused by traffic accidents. METHODS: A total of 43 patients with limb arterial injury admitted in our department over the past 30 years (about 50% of them happened during the last 10 years) were analyzed retrospectively in this article. The popliteal, femoral and brachial arteries were mainly involved, accounting for 43.2%, 20.5% and 20.5% respectively of all the involvements. There were 35 cases of open injury and 9 of close injury. The involved vessels were transected in 43.2% of the cases and contused in 40.9%. All the patients had various complications, such as fractures, dislocations and severe soft tissue injuries. The injured vessels were repaired by means of end-to-end anastomosis in 10 cases, autogenous vein graft in 23 cases and intraluminal hydraulic dilatation in 4 cases. RESULTS: Successful limb salvage was achieved in 34 cases initially, whereas 10 amputations were carried out due to injuries to popliteal arteries in 7, femoral arteries in 2 and humeral artery in 1 and severe soft tissue damages in 9 cases. Twenty-nine patients were followed up for 1-156 months, with the average of 48.8 months. There was good circulation in 22 cases and certain ischemia in 5 cases. Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2 cases. There was no death in this series. CONCLUSIONS: The limb arterial injuries caused by traffic accidents are severe and complicated. It is proposed that particular attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.

[Compliance variation following the change of longitudinal stretch ratio. A study on femoral artery and vein in a rabbit model].

This study was aimed to establish a rabbit model of bridging artery defect with autogenous vein under equal arterial and venous compliances by selecting an appropriate anastomosing tension based on assessing the influence of vessel's longitudinal strain on compliance. The exponential form P = M1 x [eM2(v-v0)-1] was employed to fit the blood pressure-unit volume curves under different stretch ratios(lambda) obtained from real curves on 13 femoral arteries and 12 veins whose uniaxial loading tests at longitudinal directions had been performed, then the quantic M = a1 lambda 5 + a2 lambda 4 + a3 lambda 3 + a lambda 2 + a5 lambda + a6 was done to fit M-lambda data. Results showed the differential form dv/dp = 1/(M1 x M2 + 11.78 M2) derived from P = M1 x [eM2(v-v0)-1], and lambda reflected the relationship between compliance and stretch ratio (or longitudinal tension) under average artery pressure 11.78 KPa well. It was found that under longitudinal tension 1.19 g, the arterial and venous compliances were equal(0.031 microliter/KPa) while the respective stretch ratios were 1.32 and 1.67.

[Histopathology of congenital pseudarthrosis of tibia].

OBJECTIVE: To investigate the histopathology, origin, and etiology of congenital pseudarthrosis (CPT). METHODS: Specimens of periosteum from 28 CPT cases, 20 cases of traumatic pseudarthrosis (TP), 10 cases of fibromatosis, and 10 normal controls were examined. The pathological changes were observed by electron microscopy and confocal microscopy. The expression of alpha-smooth muscle (SM) actin, vimentin, desmin, bone morphogenic protein (BMP), interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-alpha) and base fibroblast growth factor (b-FGF) were detected by histochemistry and immunofluorescence chemical staining. Chromosomal karyotype was examined among 11 cases of CPT. RESULTS: (1) Electron microscopy showed that the periosteum and soft tissue between the broken ends in CPT were all dense fibrous connective tissue abundant in cells, including fibroblasts, myofibroblasts, etc. (2) The chief collagen element was type I collagen in normal periosteum and was type III collagen in periosteum of patients with CPT and fibromatosis (P < 0.025). (3) Vimentin was positive and desmin was negative in all specimens. The expression of alpha-SM actin was higher in specimens from CPT and fibromatosis than in specimens from normal control and TP (P < 0.01). The expression of BMP was higher in normal periosteum and TP than in the periosteum of CPT and fibromatosis (P < 0.05). The expression of IL-1, IL-6, TNF-alpha, b-FGF was higher in the periosteum of CPT and TP (P < 0.01). (4) The chromosomal karyotype of all CPT patients was normal 46XY or 46XX. CONCLUSION: (1) Neurofibromatosis is probably not the etiological factor of CPT. (2) CPT is a kind of invasive fibromatosis located in periosteum. (3) Abnormal expression of many kinds of cytokine and high expression of type III collagen play an important role in the pathogenesis of CPT. (4) The main pathology of CPT is hyperplasia of fibroblasts, thus causing thickening of periosteum, contractible circinate coarctation, and compression of tibia and surrounding tissues. (5) The chromosomal karyotype of patients with CPT is normal.

Study of L-arginine-nitric oxide pathway in ischemia-reperfusion injured limbs in rats.

OBJECTIVE: To observe the change of nitric oxide (NO) levels in the blood and the morphological change of the muscles in the limbs of rats during the (IR) injury and after being intervened by L-arginine (L-Arg) and L-nitroarginine (L-NNA). METHODS: Sixty-six male Sprague-Dawley (SD) rats were used an d grouped into the normal controls, the sham injury controls, the IR injury group and the intervention groups (L-Arg group and L-NNA group). After 6 hours of ischemia, followed by reperfusion for 3, 12 or 24 hours, the samples in the IR injury group were obtained. The rats in the intervention groups were given L-Ar g (100 mmol/L) and L-NNA (10 mmol/L), respectively, through the abdominal cavity. Then the anterior tibial muscle in the right limb was obtained for histological examination, the anterior tibial muscle in the left limb for ultrastructure observation and the blood for assay of NO in all the rats. NO was assayed by indirect measurement of NO(2)(-)/NO(3)(-) with Griess method. RESULTS: There was no significant difference of NO between the normal controls and the sham injury controls (P>0.05). But NO significantly decreased in the IR injury group (P<0.01), and further decreased with reperfusion (P<0.01) and reached the lowest point at 12 hours after reperfusion. The level of NO in the L-Arg group was significantly higher than that in the IR injury group ( P<0.01), but was not significantly different from that in the controls (P>0.05). In the L-NNA group, NO decreased to the undetectable level (P<0.01). Histological examination and ultrastructure observation showed the muscles were normal in the control groups. After 6 hours of ischemia, the skeletal muscles displayed injuries, and they were most severely injure d after 12 hours of reperfusion. In the L-Arg group, the skeletal muscles were less injured, while in the L-NNA group, the injury was similar to that in the I R injury group. CONCLUSIONS: When the limbs of the rats sustain IR, NO in the blood decreases. Meanwhile, the muscles in the limbs are injured. When L-Arg is given, NO in the blood is restored and the muscles are protected. When L-NNA completely inhibits NO, no protection of the muscles is shown.