Background Heideberg retina tomography Ⅱ(HRTⅡ) can offer the quantitative description of optic disc topography and optic nerve fiber layer thickness.The normal optic disc parameter by HRT Ⅱ from Chinese has been reported,but the comparisons between males and females or the left and right eyes are lack.ObjectiveThe goal of this study is to measure the optic disc topography of healthy people with HRT-Ⅱ.Methods Four hundreds eyes from 108 healthy male subjects and 92 healthy female subjects aged 10-72 years were measured with HRT Ⅱ in this study.The parameters of optic disc including disc area,cup area,rim area,cup/disc area ratio,rim/disc area ratio,cup volume,rim volume,cup depth,maximal cup depth,height variation,mean RNFL thickness,and RNFL cross-sectional area were analyzed and compared between the gender or left and right eyes.Oral informed consent was obtained from all of the subjects before this procedure.Results There were no significant differences in measuring parameters by HRTⅡ between female and male subjects (P＞0.05) or between right eye and left eye (P＞0.05).Conclusion The results can be used as a normal reference of optic disc parameters of HRT Ⅱ.

Objective: To study the expressions of microRNA-221 (miR-221) and the protein of phosphatase and tension protein homologue (PTEN) in the proximal and distal stumps after sciatic nerve injury in rats and their correlation with the repair of peripheral nerve injury, so as to provide a new target for clinical diagnosis of peripheral nerve injury. Methods: Ninety-six male Sprague-Dawley rats of SPF grade were selected to establish sciatic nerve injury models. Twenty-four rats were sacrificed at 0 (immediately after operation), 1, 4, and 7 days after operation. The proximal and distal sciatic nerve fragments were taken under aseptic conditions. The expression of miR-221 was detected by real-time fluorescent quantitative PCR, and the expression of PTEN protein was detected by Western blot and immunofluorescent staining. The relationship between miR-221 and PTEN was verified by dual-luciferase reporter gene. At the same time, the ultrastructure of nerve stump was observed by transmission electron microscopy. Results: The results of real-time fluorescent quantitative PCR, Western blot, and immunofluorescence staining showed that the relative expression of miR-221 in the proximal and distal stumps increased gradually with time, and the relative expression of PTEN protein decreased gradually, and the differences between different time points after operation were significant ( P<0.05). At 1, 4, and 7 days after operation, the relative expression of miR-221 in proximal stump was significantly higher than that in distal stump, and the relative expression of PTEN protein in proximal stump was significantly lower than that in distal stump ( P<0.05). Dual-luciferase reporter gene suggested that PTEN was the target for miR-221. Transmission electron microscopy observation showed that the normal morphological structure was observed at 0 day after operation, and the proliferation of Schwann cells and degeneration of axons and myelin sheaths gradually increased with time. There was no significant difference between proximal and distal stumps at 1 day after operation. At 4 and 7 days, Schwann cells proliferated more in proximal stump than in distal stump, and the degeneration of axons and myelin sheaths was less. Conclusion: After sciatic nerve injury in rats, the up-regulation of the miR-221 expression targets the down-regulation of PTEN expression, which results in the difference of expression levels of miR-221 and PTEN in proximal and distal stumps. This phenomenon may play a role in promoting nerve repair after peripheral nerve injury.

Objective To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy(OT)in intensive care unit(ICU). Methods Related data were retrieved from CBM,CNKI,Wanfang Data,VIP,PubMed,EMBASE,CENTRAL,and Web of Science from the time of their establishment to May 15th 2014,and the data of randomized controlled trials(RCTs)concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software. Results A total of 12 RCTs were identified,and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time〔mean difference (MD)=-15.11,95% confidence interval(95%CI)=-17.14 to -13.07,P<0.000 01〕,reduce the volume of blood loss(MD=-17.59,95%CI=-21.90 to-13.28,P<0.000 01),reduce the size of incision(MD=-2.20, 95%CI=-2.57 to -1.82,P<0.000 01),shor ten the time of healing(MD=-3.60,95%CI=-4.15 to -3.05, P<0.000 01),and reduce complications such as infection of the wound〔odds ratio(OR)=0.20,95%CI=0.10-0.44,P<0.000 1〕and cutaneous emphysema/mediastinal emphysema(OR=0.22,95%CI=0.10-0.47,P<0.000 1)compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches. Conclusions PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality,further clinical use is warranted for a better assessment.

Objective To explore the effect of giving sedatives according to the circadian rhythm in prevention of occurrence of delirium and the prognosis of patients undergoing mechanical ventilation in intensive care unit (ICU). Methods A prospective double-blinded randomized controlled trial (RCT) was conducted. The patients admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University from July 2014 to February 2015, undergoing invasive mechanical ventilation over 12 hours were enrolled. All the patients were given fentanyl for analgesia, and they were randomly divided into simulated circadian clock group (study group, n = 35) and non-simulated circadian clock group (control group, n = 35). The patients in each group were subdivided into three subgroups according to the kinds of sedative drugs, namely dexmedetomidine group (n = 8), propofol group (n = 14), and dexmedetomidine combined with propofol group (combination group, n = 13). Visual analogue scale (VAS) standard and Richmond agitation-sedation scale (RASS) were used to control the analgesic and to quantify the depth of sedation by titrating the dose of sedative drugs, the simulated circadian clock was set to control the RASS score at 0-1 during the day, and -1 to -2 at night in study group. The RASS score in the control group was set at -1 to -2 day and night. The urine 6-hydroxy acid melatonin (aMT6s) levels at different time points in the first diurnal rhythm (06:00, 12:00, 18:00, 24:00) were determined by enzyme linked immunosorbent assay (ELISA). The incidence of delirium, severe hypotension, severe bradycardia and other adverse reactions, duration of mechanical ventilation and the time of extubation, length of ICU stay, amount of sedative and analgesic drugs used were recorded. The correlation between delirium and other indexes was analyzed by using Spearman correlation analysis. Results ① There were no significant differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score among groups. ② Urine aMT6s levels did not show circadian rhythm in both groups, aMT6s level at 06:00 in study group showed an increasing tendency as compared with the control group, but the difference was not statistically significant. ③ Compared with the control group, the incidence of delirium was significantly lowered in the study group (14.3% vs. 37.1%, P = 0.029), but no significant differences were found in the incidence of severe hypotension or severe bradycardia (20.0% vs. 25.7%, 11.4% vs. 20.0%, both P > 0.05). In simulated circadian clock group, the incidence of delirium in dexmedetomidine group was significantly lower than that of the propofol group (6.3% vs. 32.1%, P < 0.05). ④ Compared with control group with the same sedative, the duration of mechanical ventilation, extubation time, length of ICU stay were significantly shortened, and the dosage of sedative drugs used was reduced in study group (all P < 0.05). In simulated circadian clock group, the duration of mechanical ventilation in dexmedetomidine group was significantly shorter than that of propofol group and combination group (hours: 75.75±26.78 vs. 102.00±26.31 and 100.31±25.38, both P < 0.05), and the length of ICU stay was significantly shorter than that of propofol group (days: 5.75±1.04 vs. 7.00±1.52, P < 0.05). ⑤ The occurrence of delirium was positively correlated with duration of mechanical ventilation (r = 0.705), extubation time (r = 0.704), length of ICU stay (r = 0.666, all P = 0.000), and no correlation was found between the occurrence of delirium and aMT6s level at 06:00, 12:00, 18:00, and 24:00 (r = -0.135, r = 0.163, r = 0.269, r = -0.077, all P > 0.05). Conclusions Administration of sedatives according to simulating circadian time could decrease the duration of mechanical ventilation, extubation time, and the length of ICU stay, decrease the dosage of sedative drugs, and reduce the incidence of delirium. Dexmedetomidine could reduce the incidence of delirium, and improve the prognosis of patients. Trial registration Registration of clinical trials in China, ChiCTR-IPR-15006644.

Objective To analyze the status of Leishmania infantum asymptomatic infection in human population of a Kala-azar endemic area in Wenxian County,Gansu Province,and to evaluate the tests used.Methods Blood samples were tested by PCR using two pairs of primers,RV1-RV2 and K13A-K13B,for detecting Leishmania-specific DNA.ELISA and rK39-dipstick were used to detect Leishmania-specific antibodies.Results The positive rate of PCR,ELISA and rK39-dipstick was 30.9%(83/269),24.2%(65/269) and 0(0/269) respectively.Conclusion The prevalence of asymptomatic infection of L.infantum in humans is high in the area.PCR test based on RV1-RV2 and K13A-K13B primer pairs is a sensitive and specific method for detecting the asymptomatic infection.

The quality control of the surgical pathway for colorectal cancer is closely related to reducing the incidence of postoperative complications, recurrence and metastasis, prolonging survival, and preserving functions. This pathway involves multiple disciplines, stages, and contents: standardizing the diagnosis and treatment process for colorectal cancer is crucial to ensuring medical quality and safety. Strengthening perioperative management is an important essential step for accelerating postoperative recovery and improving patient prognosis. Establishing a standard training program and effective inspection system is guarantee for the quality of colorectal cancer surgery.

The quality control of the surgical pathway for colorectal cancer is closely related to reducing the incidence of postoperative complications, recurrence and metastasis, prolonging survival, and preserving functions. This pathway involves multiple disciplines, stages, and contents: standardizing the diagnosis and treatment process for colorectal cancer is crucial to ensuring medical quality and safety. Strengthening perioperative management is an important essential step for accelerating postoperative recovery and improving patient prognosis. Establishing a standard training program and effective inspection system is guarantee for the quality of colorectal cancer surgery.

Objective To investigate whether routine laboratory findings should be awaited before intravenous thrombolytic therapy for ischemic stroke.Methods Emergency patients (including ischemic and non-ischemic stroke cases) treated at the Department of Neurology,Beijing Tsinghua Changgung Hospital between January 1st 2016 and October 1st 2017 were analyzed retrospectively.The platelet count,prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR) in the first test were used as the main indicators.The proportion of patients with abnormalities between the overall population and the ischemic stroke subgroup was analyzed,and the above indicators between all patients with ischemic stroke and those receiving intravenous thrombolytic therapy were compared.The specific causes of failure to receive intravenous thrombolytic therapy in patients with ischemic stroke were analyzed descriptively.Results A total of 3 348 patients were enrolled.The emergency blood routine data were available in all patients.The emergency blood biochemical data were available in 3 278 patients (97.9％),and the emergency coagulation function data were available 1 742 patients (52.0％).There were no significant differences in the proportion of platelet count ＜ 100 × 109/L (1.3％ vs.1.5％;x2=0.29,P=0.586),APTT＞36.5s (3.8％ vs.3.6％;x2=0.06,P=0.809),PT ＞15s (2.6％ vs.2.8％;x2 =0.03,P=0.866),and INR ＞ 1.5 (2.0％ vs.2.0％;x2 =0.01,P=0.970) between the general population and the ischemic stroke subgroup.In a total of 687 patients with ischemic stroke,57 (8.3％) received intravenous thrombolysis.There were no significant difference in mean platelet count,APTT,PT,and INR between the thrombolytic group and the entire ischemic stroke group.Forty-nine patients (5.1％) with ischemic stroke had abnormal main indicators,of which 57.1％ (28/49) had a history of related diseases at the same time,while only 6.1％ (3/49) had abnormal laboratory indicators as the main factor of contraindication for intravenous thrombolysis.Conclusions Patients with acute ischemic stroke (especially in the absence of a history of related disease) have a low proportion of abnormal blood test findings and are less likely to be the main contributor of contraindication for intravenous thrombolysis.Therefore,when there is no reason to suspect that the test findings are abnormal,intravenous thrombolytic therapy should not be delayed because of waiting for the test findings.

Objective To observe the image characteristics ofmultispectral scanning laser imaging (MSLI) and OCT in patients with pregnancy induced hypertension syndrome (PIHS).Methods A total of 112 patients (224 eyes) of PIHS patients diagnosed in Obstetrics Department of Tianjin First Central Hospital from May 2016 to May 2017 were included in this study.The average age of the patients was 27.00±2.14 years.The average course of the disease was 15.00 ±8.27 days.There were 174 eyes in 87 patients of blurred vision,dazzling and visual fatigue consciously.All patients performed BCVA,direct ophthalmoscope,B ultrasound,confocal scanning laser Ophthalmoscope (cSLO) and spectral-domain OCT (SD-OCT).SD-OCT was performed with Spectralis HRA+OCT from Heidelberg Company in Germany to acquire tomographic images.Using Herdelberg's colorful program (MultiColor) based on cSLO and operating in accordance with standard methods,one scan simultaneously obtained blue light reflection based on 488 nm,green light reflection based on 515 nm,and infrared reflection based on 820 nm,synthesis to MSLI.Fundus abnormalities were classified into arterial spasm (stage Ⅰ),arteriosclerosis (stage Ⅱ),and retinopathy (stage Ⅲ).OCT examination was divided into normal and abnormal cases according to the abnormality of retinal morphology and thickness.Results Of the 224 eyes,68 eyes (30.36％) showed normal fundus examination and 156 eyes (69.64％) showed abnormal fundus performance.Among them,28 eyes were stage Ⅰ (17.95％);40 eyes were stage Ⅱ (25.64％);88 eyes were stage Ⅲ (56.41％).Thirty-six eyes (16.07％) showed normal fundus and 188 eyes (83.93％) showed abnormal performance with OCT.Of the 188 eyes with abnormal fundus performance,86 eyes (45.74％) had retinal neuroepithelial serous detachment;56 eyes (29.79％) had RPE detachment;optic disc edema,bulge,and local reflexes in the retinal nerve fiber layer were enhanced and/or the thickness increased in 46 eyes (24.47％).In MSLI,48 eyes (21.43％) showed normal fundus;176 eyes (78.57％) showed abnormal performance.Retinal edema was showed in green on MSLI,serous retinal neuroepithelial layer detachment,RPE layer detachment,retinal nerve fiber layer thickening,accompanied by changes in local retinal structure.The higher the degree of bulge,the darker the color.Consistent with the range of retinal edema revealed by SD-OCT.Conclusions MSLI and SD-OCT images show highly consistent lesions in PIHS patients.MSLI can more clearly show superficial and deep retinal lesions.

Objective To systematical evaluate the effect of Xuebijing injection in the treatment of multiple organ dysfunction syndrome (MODS).Methods With the keywords including Xuebijing, multiple organ dysfunction syndrome, multiple organ dysfunction and multiple organ failure, PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP and Wanfang Data from the database start until March 4th, 2018 were searched for relevant randomized controlled trials (RCTs) related to Xuebijing injection combined conventional treatment versus conventional treatment alone for MODS. The control group received conventional western medicine treatment, including etiological treatment, antibiotics, mechanical ventilation, nutritional support, and comprehensive treatment to maintain fluid, electrolyte, acid and alkali balance. The experimental group was given traditional western medicine combined with Xuebijing injection. The observation parameters included 7-day and 28-day mortality, acute physiology and chronic health evaluationⅡ (APACHEⅡ) and Marshall score, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), the number of platelets, activated partial thromboplastin time (APTT) and prothrombin time (PT). According to the inclusion and exclusion criteria, two evaluators independently screened the literature, extracted data and evaluated the methodological quality of the included studies. RevMan 5.3 software was used for Meta analysis. Funnel plot was used to analyze publication bias.Results A total of 35 RCTs and 2131 patients were enrolled, including 1076 in the experimental group and 1055 in the control group. The results of Meta analysis showed that compared with control group, Xuebijing combined conventional treatment was in favor to decrease the mortality of patients with MODS [7-day mortality: odds ratio (OR) = 0.42, 99％ confidence interval (99％CI) = 0.26-0.69,P < 0.00001; 28-day mortality:OR= 0.31, 99％CI= 0.21-0.45,P < 0.00001], also could obviously reduce critical condition degree of APACHE Ⅱ score and the organ function of Marshall score [APACHEⅡ: mean difference (MD) =3.24, 99％CI = 2.00-4.49,P < 0.00001; Marshall score:MD = 1.95, 99％CI = 0.50-3.40,P = 0.0005]. Meanwhile, the results of conventional western medicine combined with Xuebijing in the removal of IL-6 and TNF-α, platelets increase and improvement of PT were better than those of conventional western medicine (IL-6:MD = 5.56, 99％CI = 1.44-9.68, P = 0.0005; TNF-α:MD = 4.97, 99％CI = 3.44-6.50,P < 0.00001; platelets:MD = -50.79, 99％CI = -74.84 to -26.74, P < 0.0001; PT:MD = 4.55, 99％CI = 3.96-5.14,P < 0.00001), however, there was no obvious advantage in improving APTT (MD = 0.96, 99％CI = -5.08-7.00,P = 0.68). The analysis of funnel map showed that the effect points of various studies were mainly centered on the amount of combined effect, and the "inverted funnel" type was generally symmetrical distribution. However, because the number of the included studies was less, the literature bias could not be completely eliminated.Conclusion Xuebijing injection may through its strong cytokines clearance, platelet increase and blood coagulation improvement to protect the organ function in patients with MODS, so as to reduce the mortality and improve the prognosis.