Objective　To evaluate the clinical efficiency of diode laser transscleral cyclophotocoagulation(TSCPC) for the treatment of refractory glaucoma.Methods　TSCPC were performed in 23 eyes of 23 patients with medically and surgically uncontrolled glaucoma. The laser was operated with a power of 2～3W,duration of 1.5～2s and laser spots(18) were evenly placed 270 around the limbus except temporal. Followed for 3～24 months (average:11 months) . Results　The mean intraocular pressure before and after treatment in 23 eyes were 6.10kPa±2.34kPa and 2.55kPa±1.22kPa respectively,which was statistically significant (P<0.01). IOP below 2.80kPa was obtained in 20 eyes (86.9%). At the time of last visit,the post-operative visual acuity was partly improved besides NLP.Conclusion　Diode laser transscleral cyclophotocoagulation is effective in treating refractory glaucoma. Its advantages are low ratio of ocular hypotension,no atrophy of eyeball,no pain, acceptability,reoperation and therapeuty in clinic and so on.

Hepatocellular carcinoma(HCC)is nowadays one of the leading common causes of cancer death and mostly occurs in hepatitis B endemic areas.Typically,HCC patients presented late and only about 20% of the patients are amendable to surgical interventions.Surgical resection is the main curative treatment option.Nevertheless,the recurrence rate after potential curative liver resection is still very high.On the other hand,liver transplantation is the treatment of choice for early small HCC but its application is limited by the availability of liver grafts.Radiofrequency ablation is more commonly used in cirrhotic patients with small tumours who are not surgical candidates.Nowadays,transarterial chemoembolisation,drugeluting bead transarterial chemoembolisation and radioembolisation are the mainstay of treatments for the patients with intermediate HCC.Other systemic approaches,such as hormonal therapy,immunotherapy and chemotherapy have disappointing results.In particular,HCC is highly refractory to cytotoxic chemotherapy.This is no convincing evidence thus far that systemic chemotherapy improves overall survival in advanced HCC patients.Recently,encouraging results have been shown in using sorafenib in the treatment of advanced HCC patients.Similar to sorafenib,other anti-angiogenic multi-targeted tyrosine kinase inhibitors,such as pazopanib,brivanib and axitinib also show promising activity in various stages of clinical trials.There is an urgent need to identify biomarkers that may guide the rational use of sorafenib and other targeted agents in the era of personalised medicine.More importantly,the multidisciplinary model in managing HCC patients is the important key to the future success.

Objective To investigate the feasibility and indications of laparoscopic liver resection. Methods Five patients with small hepatocellular carcinoma in the left lateral lobe underwent laparoscopic liver resection from April 2002 to April 2003. The Endo-vascular GIA was employed to transect the liver parenchyma from the right side of the lesion. The resected liver tissues and tumor were removed via the prolonged incision. Results Laparoscopic hepatectomy was successfully accomplished in 3 cases, while conversions to open surgery were required in 2 cases because of severe hemorrhage or excessive thickness of resecting marge. There were no exudation or bile leakage on the cut surface of laparoscopic hepatectomy. The length of duration of laparoscopic hepatectomy ranged from 60 min to 90 min. The patients were dismissed 3～5 days after the surgery. No complications occurred. Conclusions Liver tumor in the left lateral lobe can be removed laparoscopically.

Objective To explore ultrasonographic characteristics and prognosis of cesarean scar pregnancy in the ultrasound.Methods To conducted a retrospective study of 8 cases of diagnoses of cesarean scar pregnancy in ultrasound in our hospital from January 2013 to August 2015.All cases had ultrasonographic examinations regularly during the pregnancy and were confirmed placenta increta by cesarean section or prenatal MRI (6 cases).The imaging characteristics of 8 cases of pregnant women in early pregnancy by transvaginal ultrasound,and the positions of gestational sac and chorion frondosum were observed.Ultrasonic follow-up results,numbers of cesarean delivery,final diagnosis,and pregnancy outcome were analyzed.Results Eight cases of patients were diagnosed cesarean scar pregnancy,and all of ceses were diagnosed placenta increta by ultrasound from 11 weeks to 24 weeks of gestation.It was found that the positions of chorion frondosum were located in the lower edge of gestational sac in Two-dimensional ultrasound and the chorion frondosum was covered in cesarean section scar.The echoes of proliferous chorion frondosum were stronger than the rest of chorion leve and decidua reflexa,and the thickness of proliferous chorion frondosum were thicker than the rest of chorion leve and decidua reflexa.In the follow-up ultrasound of 8 cases in the second trimester,the original position of chorion frondosum which covered and the position of placenta were roughly similar.The position of placenta did not move up with the gestational weeks,in addition,appeared as placenta previa and covered in cesarean section scar.Five patients had strong childbearing willing of continue to conceive,one case of which needed hysterectomy,four of which underwent cesarean section delivery with alive births after using bilateral iliac arteries balloon occlusion.The rest 3 cases underwent induction of labor after using bilateral iliac arteries balloon cclusion.Conclusions Cesarean scar pregnancy in first pregnancy may be develop as placenta accreta in second and third trimester pregnancy.If chorion frondosum was observed to cover cesarean section scar by ultrasound in early pregnancy,scar pregnancy diagnosis was established.Pregnant women who have strong willing to continue their pregnancy should be pay more attentin to thiers placenta previa and placenta percreta in second and third trimester pregnancy.Close follow-up are needed.

The levels of low-density lipoprotein(LDL)glycation from control group,diabetic HbA1C < 7.0%,and HbA1C>7.0% groups were(17.7±2.31),(34.29±5.73),and(48.79±7.82)Glycogroups/LDL by fluorimetry.The LDL binding to its receptor in three groups were(37.65±5.20),(27.36±4.34),and(15.07± 2.23)ng/mg cell protein measured by enzyme-linked immunoreceptor assay.The glycated levels in two diabetic groups were higher than that in control group,and higher in HbA1C>7.0% group than in HbA1C<7.0% group(all P< 0.01).The results of LDL binding capacity to its receptor were just the opposite.

Objective To discuss the clinical features of behavioral and psychological symptoms of demen-tia(BPSD)and the relation between different sub-clinical syndromes and cognition. Methods One hundred and sixteen dementia patients were assessed with neuropsychiatric inventory and mini-mental state examination (MMSE)and made factor analysis according to DSM-IV-R. Results Twelve common behavioral and psychological symptoms could be further divided into five sub-syndromes,including disinhibition behavior,psychosis,agitation, emotion and apathy factors. MMSE total score and years of education entered regression equation of apathy factor (P<0.05). Conclusion BPSD can be divided into five factors and apathy factor are related with cognitive function.

OBJECTIVETo determine the mutational profile and clinical implications of the viral reverse-transcriptase (rt)A 181T mutation in hepatitis B virus (HBV) through population-based analysis of clinical samples.

METHODSSerum samples from 3, 013 patients who visited The 302 Hospital (Beijing, China) were investigated.HBV DNA was extracted and HBV mutations and genotypes were determined by direct sequencing.Recombinant plasmids harboring the rtA181T/sW172* mutant or wild type sequence were constructed and transfected into the HepG2 cell line. The levels of HBsAg in culture supernatants were compared and statistically analyzed.

RESULTSThe incidence of rtA181T across the study population was 4.1% (165/3, 013), and most of the rtAl 81T-positive patients had received adefovir and/or lamivudine.Forty percent (66/165) of the rtA 181T cases were single mutants and treatment responsive, 46.1% (76/165) included the adefovir-resistant mutation rtA 181 V/N236T, 12.1% (20/165) included the lamivudine-resistant mutation rtM204V/rtM2041, and 1.8% (3/165) included multidrug-resistant mutations.Interestingly, 73.9% (122/165) of the rtA181T-positive samples were detected with co-existing wild-type nucleotides at the site. The rates of HBV/C to HBV/B were 92.1% to 7.9% in the rtA181T-positive patients, but 82.1% to 17.9% in the rtA181T-negative paticnts (P less than 0.01).Almost all (98.2%; 129/165) of the rtA181T led to sW172*, while only 1.8% of the rtA181T (3/165) led to sW172L or sW172S.HBsAg secretion in vitro was reduced from the rtA181T/ sW172* strain, but there was no significant difference observed in the average serum HBsAg and HBV DNA levels of patients who carried or did not carry the mutant.

CONCLUSIONThe HBV rtA181T mutation is closely associated with adefovir and lamivudine exposure.rtA181T may led to sW172*, culminating in suppression of HBsAg secretion.However, co-existence of the mutant with wild-type sequences was common among our patient population, suggesting that the mutation had little impact on serum HBsAg and HBV DNA levels across the clinical study population.

Adenine ; analogs & derivatives ; Antiviral Agents ; China ; Genotype ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Lamivudine ; Mutation ; Organophosphonates

Objective To explore the risk factors of hidden blood loss after UKA.Methods A retrospec-tive study was conducted on 273 patients who underwent UKA from January 2015 to December 2016,including 79 males and 194 females,age between 46 to 87 years old,mean age(67.21± 8.23)years old. The clinical data were collected and the blood volume was calculated according to the Nadler formula. The Gross equation was used to calculate the blood loss and the amount of occult blood loss at 3 days after operation. The risk factors were analyzed statistically. Results The volume of hidden blood loss after operation was(75.36 ± 10.21)mL,and the volume of total blood lost after operation was(187.35± 60.31)mL.Sex,BMI and type of prosthesis were risk factors for hidden blood loss after UKA. Conclusions The volume of hidden blood loss after UKA was related to sex, BMI,and type of prosthesis. For the obese and male patients,we should actively take bleeding management and choose the type of prosthesis reasonably.

Objective:To investigate the influencing factors of headache degree in migraine patients with patent foramen ovale (PFO).Methods:The clinical data of 124 migraine patients with PFO from January 2013 to June 2019 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed. The right-to-left shunt of PFO was assessed by contrast-enhanced transcranial Doppler (c-TCD); the diameter of PFO, length of PFO tunnel and the presence of atrial septal aneurysm (ASA) were detected by transesophageal echocardiography (TEE); the degree of migraine was assessed by headache impact test-6 (HIT-6) scale. The relations between right-to-left shunt volume of PFO, diameter of PFO and degree of migraine were analyzed by Goodman-Kruskal γ test; the relations between the length of PFO tunnel, ASA and degree of migraine were analyzed by Spearman rank correlation analysis.Results:Among the 124 migraine patients with PFO, the c-TCD test result showed that small shunt volume was in 20 cases, medium shunt volume in 31 cases, and large shunt volume in 73 cases. The TEE test result showed that small foramen ovale in 76 cases, medium foramen ovale in 47 cases, and large foramen ovale in 1 case; long tunnel in 57 cases, and short tunnel in 67 cases; without ASA in 91 cases, and with ASA in 33 cases. The HIT-6 score result showed that some influence in 9 cases, significantly influence in 22 cases, and serious influence in 93 cases. The Goodman-Kruskal γ test result showed that right-to-left shunt volume of PFO and diameter of PFO were positive correlation with degree of migraine ( γ = 0.66, P<0.01; γ = 0.38, P<0.05). The Spearman rank correlation analysis result showed that ASA was positive correlation with degree of migraine ( r = 0.18, P<0.05), while the length of PFO tunnel was negative correlation with degree of migraine ( r = -0.23, P<0.05). Conclusions:The right to left shunt amount of PFO, diameter of PFO and the presence of ASA are positive correlation with degree of migraine, while the length of PFO tunnel is negative correlation with degree of migraine.

Objective : To observe the changes of soft tissue in patients with Angle class Ⅱ division Ⅰ malocclusion during mixed dentition treated with MRC functional appliance. Methods : Twenty patients with Class Ⅱ division Ⅰ malocclusion of Angle were treated with functional MRC. The facial features before and after treatment were measured by software and the results were analyzed statistically. Results: The patients′soft tissue profiles were improved significantly before and after treatment, The OE-Prn-Pos angle, OE-N′-B′ angle, OE-N′-Pos angle, OE-Prn-N′angle, Cm-Sn-UL angle, and N′-Sn-Pos angle increased significantly (P < 0.05). The OE-Sn-UL angle, and Sn-N′-B′ angle decreased significantly (P < 0.05); the distance between the lateral soft tissue line and the middle Sn-H line, UL-E line and LL-E line were significantly different (P < 0.05). The distances were all reduced, and the difference was statistically significant (P < 0.05). Conclusion The application of an MRC functional appliance can improve the relationship among nasolabial soft tissue, upper and lower lip soft tissue, and chin-lip soft tissue, thus improving the protrusion profile of patients.