AIM: To explore the long-term efficacy of Q-factor guided laser epithelial keratomleusis ( LASEK ) for myopia and astigmatism with positive Q-factor.
METHODS: There were 158 eyes which were myopia and astigmatism with positive Q- factor taken in two groups randomly: 86 eyes accepted Q - factor guided LASEK as observation group and 72 eyes accepted routine LASEK as control group. The difference between the two groups about all data was similar. The uncorrected visual acuity ( UCVA ) and the best corrected visual acuity ( BCVA ) as well as diopter, ocular tension, corneal topography, Keratometry value K, aspherical factor Q, Higher-order aberrations ( HOA ) , corneal thickness by ultrasound and, contrast sensitivity ( CS ) , Haze were examined and compared before and after surgery. All the cased were followed up for 14d, 1, 3, 6, 12mo. And there were no statistical difference among the data before surgery.
RESULTS: After 12mo there were no statistical difference between the two groups about UCVA and BCVA. But the safety index of observation group was 1.10, that of control group was 1. 07. The validity index of observation group was 1. 06, that of control group was 0.99. The HOA of observation group was 0. 45±0. 17μm, and that of control group was 0. 72±0.25μm, there was statistically significant difference (t=-8. 193,P=0. 000). Q factor of observation group was 0. 41±0. 17, that of control group was 0. 77±0. 22, there was significant difference (t=11. 377,P = 0. 028). The contrast sensitivity of 3mo post surgery of patients in the observation group returned to the level of before surgery. But in the control group the contrast sensitivity of the patients did not returned until 6mo.
CONCLUSION:Q-factor guided LASEK for myopia and astigmatism with positive Q-factor is stable, safe and effective. The operation allow for reducing the high order aberrations, maintaining the most asphericity of cornea, saving more in corneal tissue, which cause faster recovery of contrast sensitivity, less haze and better visual quality.

Objective To investigate the effect of porous silk fibroin scaffolds (PSFSs) combined with chondroitinase ABC (ChABC)for treatment of rats with spinal cord injury (SCI).Methods After exposed to T9 spinal cord transection injury,96 SD rats were divided into control group,PSFSs group,ChABC group,and PSFSs plus ChABC group according to random number table.BBB scoring system was used to evaluate hindlimb motor function in rats.Immunohistochemistry and Western blot analysis were performed to detect expression levels of neurofilament-200 (NF-200),glial fibrillary acidic protein (GFAP),and growth associated protein-43 (GAP-43) of the injured spinal cord.Immuno-fluorescence staining was carried out to evaluate regeneration of nerve fiber.Results BBB score improved in PSFSs group (8.1 ± 0.8),ChABC group (9.0 ± 1.1),and PSFSs plus ChABC group (13.7 ± 1.3) compared with control group 4 weeks after injury (5.3 ±0.7,P ＜0.05).Immunohistochemistry showed higher integral absorbance (IA) values of NF-200 and GAP-43 in those treatment groups,but smaller GFAP-positive area was observed compared with control group (P ＜ 0.05).Immuno-fluorescence staining indicated more GAP-43 growth at injury sites in PSFSs plus ChABC group in contrast with other 3 groups.Western blotting showed levels of NF-200,GFAP,and GAP-43 differed among groups (P ＜ 0.05).Conclusion PSFSs combined with chondroitinase ABC transplantation can enhance axonal regeneration,inhibit glial scar proliferation and hence promote motor function recovery.

AIM:To investigate the effect of N-[N-(3,5-difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester (DAPT) on the Notch signaling pathway in a model of oxidized low-density lipoprotein (ox-LDL)-induced human umbilical vein endothelial cell (HUVEC) damage.METHODS:HUVECs were divided into control group, ox-LDL group, DAPT group and ox-LDL+DAPT group.The morphological changes of the HUVECs with different treatments were observed under light microscope.The viability of the HUVECs was measured by CCK-8 assay.The protein expression levels of Notch1, Notch4 and Jagged1 were determined by Western blot.RESULTS:ox-LDL induced great damage to the HUVECs, evidenced by increased cell death and debris in the culture.However, the cell damage was abolished by adding DAPT into the culture.The viability of the HUVECs was increased by co-treatment with DAPT and ox-LDL.ox-LDL treatment significantly decreased the protein expression levels of Notch1 and Jagged1, and elevated Notch4.However, these changes were totally reversed by DAPT.None of these proteins showed significant change in the HUVECs co-treated with DAPT and ox-LDL as compared with control group.CONCLUSION:ox-LDL is able to induce HUVEC damage in vitro.DAPT attenuates ox-LDL-induced damage in the HUVECs by regulating the Notch signaling pathway.

Objective To discuss the diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) in children suffering from malignant solid tumor with concurrent infection and in tumor progressing stage.Methods A total of 94 cases of malignant solid tumor at Department of Pediatrics,Beijing Tongren Hospital,Capital Medical University from March to August 2016,were collected and divided into 2 groups:infection group (n =17) and non-infection group (control group,n =77).Meanwhile,the control group were further divided into stable tumor group (n =48) and the advanced tumor group (n =29).All of the serum specimens were detected for PCT and CRP levels.PCT and CRP levels were compared and statistically analyzed among different groups.The median(four digit spacing) was used to describe the data.Results PCT level significantly increased in the infection group [0.67 (1.35) μg/L] compared with that of the control group [0.09 (0.08) μg/L],and the difference was statistically significant (Z =-6.371,P =0.000).CRP level significantly increased in the infection group[95.00(93.42) mg/L] compared with that of the control group[1.99 (12.49) mg/L],and the difference was statistically significant (Z =-5.555,P =0.000).During diagnosing infection,the area under the receiver operating characteristic curve (ROC curve) of PCT was 0.995(95％ CI:0.987-1.000),and the area under the ROC curve of CRP was 0.932(95％ CI:0.876-0.988);when the cutoff value of PCT was 0.468 μg/L,the sensitivity was 76.5％,and the specificity was 100.0％;when the cutoff value of CRP was 10.17 mg/L,the sensitivity was 88.2％,and the specificity was 72.7％.Compared to stable tumor group,PCT level of advanced tumor group significantly increased[0.12 (0.08) μg/L vs.0.07 (0.06) μg/L],and the difference was statistically significant(Z =-2.886,P =0.004);CRP level of the advanced tumor group sig nificantly increased [10.34 (27.84) mg/L vs.1.02 (2.12) mg/L],and the difference was statistically significant (Z =-4.862,P =0.000).During diagnosing tumor progression,the area under the ROC curve of PCT was 0.697 (95 ％ CI:0.572-0.823),and the area under the ROC curve of CRP was 0.832(95％ CI:0.738-0.926);when the cutoff value of PCT was 0.094 μg/L,the sensitivity was 72.4％,and the specificity was 66.7％;when the cutoff value of CRP was 2.39 mg/L,the sensitivity was 72.4％,the specificity was 72.9％.Correlation analysis showed that the PCT and CRP levels were positively associated with tumor progression,and the correlation of CRP (r =0.558,P =0.000) was much higher than that of PCT (r =0.331,P =0.003).Conclusions Both serum PCT and CRP are effective indicators in diagnosing tumor with concurrent infection.PCT is better in diagnosing infection than CRP,and is less influenced by tumor.CRP is a better way to identify whether tumor was in progress than PCT.Joint detection of 2 indexes in identification of children suffering from malignant solid tumor with concurrent infection and in progress has practical value for the diagnosis and treatment.

Objective To evaluate the effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma.Methods Sixty ASA I or II patients undergo-ing radical resection of rectal carcinoma were randomly divided into 3 groups(n =20 each):dexmedetomidine group (group D),tramadol group(group T),control group(group C).Group D was given dexmedetomidine intravenously at 1μg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5μg·kg -1 ·h -1 until the abdo-men was closed,and group T was given tramadol intravenously at 1.5mg/kg 15min before induction of anesthesia fol-lowed by a continuous infusion of 0.5mg·kg -1 ·h -1 until the abdomen was closed,whereas group C received the same volume of normal saline.Venous blood samples were taken at 30min before anesthesia induction(T1 ),1 h after the beginning of the operation(T2 ),1h after operation(T3 ),24h after operation(T4 )for determination of blood con-centrations of glucose(BG),insulin(INS),interleukin -6 (IL -6),tumor necrosis factor -α(TNF -α).Insulin resistance(HOMA -IR)and insulin sensitivity index(QUICKI)were calculated.The numbers of patients with PONV were studied respectively.Results The serum IL -6,TNF -α,BG,INS concentrations and HOMA -IR were signifi-cantly lower while ISI was significantly higher in both group D[t =7.71,3.37,8.78,8.73,11.45,2.82(T2 ),3.04, 2.95,12.75,10.73,16.09,2.92(T3 ),11.26,2.45,11.40,5.10,14.5,2.51(T4 ),all P <0.05]and group T[t =3.02,2.59,2.93,7.76,6.32,2.03(T2 ),8.78,2.27,4.14,8.83,7.68,2.12(T3 ),6.10,2.05,3.71,2.35,7.12, 2.09(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group C.The serum TNF -αconcentration and HOMA -IR were significantly lower while ISI was significantly higher in group D[t =6.68,4.58,2.05 (T2 ),9.01,6.66,2.23 (T3 ),7.54,5.5,2.02(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group T.The numbers of patients with PONV were significantly higher in group T than those in group D and group C (χ2 =26.13,18.75,all P <0.05 ). Conclusion Both dexmedetomidine and tramadol can attenuate perioperative insulin resistance in patients undergo-ing Radical Resection of Rectal Carcinoma,and the decrease the consentrations of IL -6 and TNF -αmay be involved in the mechanism.The roles of prevention of perioperative insulin resistance in dexmedetomidine group are superior to tramadol group.The incidence of PONV is less in a dexmedetomidine group than that in a tramadol group.

OBJECTIVE To evaluate the difference of efficacy of sublingual immunotherapy on different age patients with allergic rhinitis. METHODS 229 patients with dermatophagoides farina drops allergic rhinitis who have finished SLIT at least 2 years were enrolled and analyzed by retrospective analysis. All patients were divided into different age groups: pre-adolescence(n=107), adolescence(n=53), adulthood(n=69). Indexes for therapeutic effects of SLIT visual analogue scale(VAS) score, rhinitis symptom scores, medication scoreintra- and inter groups were assessed during different stage of treatment(3 months, 1 year and 2 years). Data were analyzed with SPSS 19.0 software. RESULTS Compared with prior treatment, after the SLIT for 3 months, 1 year, 2 years, VAS scores, rhinitis symptom scores, medication scoresof all the patients with allergic rhinitis are significantly decreased; Differences of rhinitis symptom scores(H=0.844, 4.153, 2.669, P>0.05), VAS score(H=1.356, 3.720, 0.313, P >0.05), medication scores(H=1.044, 5.841, 3.399, P>0.05) between groups had no statistical significance at different stage after treatment(3 months, 1 year and 2 years); The differences between 2 years and 1 year of SLIT treatment showed statistical significance in the VAS scores(Z=1.635, P =1.635). CONCLUSION SLIT with dust mites drops had good curative effect and security in patients with allergic rhinitis, which hadno obvious difference between different age groups.

Objective To observe the efficacy of de novo combination therapy lamivudine plus adefovir , lamivudine monotherapy and entecavir monotherapy in HBeAg-positive CHB patients with genotype B/C. Methods A total of 182 treatment-naive CHB patients in line with treatment standards of Chinese CHB prevention and treatment guidelines were randomly assigned to three groups and treated with lamivudine plus adefovir or lamivudine monotherapy or entecavir monotherapy for 48 weeks. Results Patients in three groups presented no difference in baseline levels. After treatment by three therapies , the group of lamivudine plus adefovir showed a higher biochemical response rates (12 week P < 0.01, 24 week P < 0.01, 48 week P < 0.01), HBeAg-serological rates(12 week P < 0.01, 24 week P < 0.05, 48 week P < 0.05) and completely virological response rates (12 week P < 0.05, 24 week P < 0.05, 48 week P < 0.05) than lamivudine group. In terms of biochemical response rates , the group of lamivudine plus adefovir had certain advantages when compared with entecavir group. Conclusion De novo combination therapy lamivudine plus adefovir is a good antiviral strategy for chronic hepatitis B patients with B/C genotype viral infection in China.

Objective To evaluate the effect of preoperative sleep disturbance on efficacy of postoperative analgesia and comfort in patients undergoing colorectal cancer resection surgery.Methods 60 colorectal cancer patients with elective anesthesia laparoscopic radical resection were selected.According to the presence or absence of preoperative sleep disorders,they were divided into the sleep disorder group (group A) and non-sleep disorders group (group B),30 patients in each group.Two groups of patients used the same method to maintain anesthesia induction.Intraoperative intravenous nicardipine controlled hypotension in parallel to maintain MAP 60-75mmHg,HR 65-95times/min.The patients received PCIA pump at the end of surgery.Postoperative 24h VAS scores were maintained VAS score ≤3 points,when VAS score ＞ 3 points,given the pressing PCA analgesia remedy.The remedy situation within 24 hours after surgery and comfort analgesic score were recorded.Results Compared with group B,postoperative PCIA pressing number of group A significantly increased [A group:(11 ± 5),group B:(6 ± 5),t =2.44,P ＜ 0.05].At the end of surgery,postoperative 2h,4h,8h pain scores of group A were (2.8 ± 0.4),(2.5 ± 0.7),(3.2 ± 0.6),(3.5 ± 0.5),respectively,which were significantly higher than those of group B [(1.8 ± 0.5) points,(1.8 ± 0.4) points,(1.9 ± 0.3) points,(2.9 ± 0.3) points; at the end of surgery t =5.78,postoperative 2h t =4.56,postoperative 4h t =4.17,postoperative 8h t =2.09,all P ＜ 0.05],but postoperative 12h,24h had no significant change in pain scores (P ＞ 0.05).Compared with group B,the comfort scores of A group at the end of surgery,postoperative 2h,4h,8h,12h[group A:(2.8 ±0.3) points,(2.5 ±0.9)points,(2.6 ±0.9) points,(2.5 ±0.5) points,(2.9 ± 0.6) points ; group B:(3.8 ± 0.4) points,(3.3 ± 0.5) points,(3.6 ± 0.8) points,(3.3 ± 0.3) points,(3.3 ± 0.6) points] were significantly lower (at the end of surgery t =9.87 ; postoperative 2h t =4.94 ; postoperative 4h t =6.87 ; postoperative 8h t =7.61 ; postoperative 12h t--2.79,all P ＜ 0.05),after 24h comfort score had no significant change (P ＞ 0.05).Conclusion Preoperative sleep disorders can affect laparoscopic colorectal cancer after radical surgery analgesia and comfort of patients.

Objective To observe the effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients .Methods 60 cases of elderly patients for elective colorectal cancer resection ,ASAⅠ~Ⅱgrade anesthesia were selected .According to randomly digital table , they were divided into the dexmedetomidine given group ( group D) and control group ( group C),30 cases in each group.The patients of group D was given to 0.5μg/kg dexmedetomidine for induction of anesthesia infusion , 15minutes bolus injection was completed ,intraoperative maintain 0.2μg· kg-1 · h-1 dexmedetomidine fixed to the front end of surgery 10 min.And group C was given to infusion of 0.9%sodium chloride injection in the same capacity . The operation time, amount of fentanyl using , comfort and VAS scores were recorded within 24h, maintain VAS score≤3 points.When VAS score>3 points,the pressing PCA was given ,and the number of times of pressing the PCIA was recorded.The adverse reactions occurred within 24h such as nausea and vomiting were also recorded . Results In the two groups,the results of postoperative analgesia were good ,but the VAS score of group D at each time of PCA point were less than those of group C (tend of surgery =5.99,tafter operation 2h =4.76,tafter operation 4h =4.08,all P<0.01).The Bruggrmann comfort score of group D were greater than those of group C (tend of surgery =9.86,tafter operation 2h =4.91,tafter operation 4h =6.84,all P<0.01).The incidence of adverse reactions of group D was 13.30%,which was less than 26.67%of group C(χ2 =4.32,P<0.05).Conclusion Small doses of dexmedetomidine given to improve the analgesic effect in elderly patients with colorectal cancer cure can improve comfort and reduce the incidence of adverse reactions ,and has a role in reducing postoperative nausea and vomiting .

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P<0.05).In T5 period,the levels of blood glucose (5.3 ±1.1)mmol/L and cortisol (402 ±78) nmol/L and ( 0.260 ±0.044 ) ng/L in group D were significantly lower than ( 5.9 ±1.2 ) mmol/L, (550 ±92)nmol/L,IL-6 (0.300 ±0.066)ng/L in group N(t=2.02,6.72,2.76,all P<0.05).However,the composite of dexmedetomidine group D patients with respiratory recovery time(7.5 ±2.3)min,calling the eyes open time(7.8 ±2.5) min,pull out the time of endotracheal tube (14.2 ±3.3) min compared with groups N of patients with respiratory recovery time (7.8 ±2.5)min,calling the eyes (14.8 ±3.2)min,pull out the time of endotracheal tube (13.9 ±3.1)min,showed no statistical significance (t=0.88,0.44,0.36,all P>0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.