Background Tear hyperosmosis is considered to be one of the core mechanisms of dry eye.The measurement of tear osmolarity is important in the clinical diagnosis of dry eye.However,relevant study is lack in Chinese population.Objective The aim was to investigate the relation of tear osmolarity and pathogenesis of dry eye and evaluate the diagnosis value of tear hyperosmosis in dry eye.Methods Sixty-one consecutive dry eye patients were enrolled in Affiliated Eye Hospital of Wenzhou Medical University from May to August in 2011,including 30 mild and moderate dry eyes and 31 severe dry eyes,and 30 normal volunteers with matched age and gender were collected simultaneously under the informed consent.The visual acuity,Ocular Surface Disease Index (OSDI) questionnaire,osmotic pressure of tear,tear film breakup time (TFBUT),corneal fluorescein staining,conjunctival lissamine green staining,Shirmer Ⅰ test (S Ⅰ t) without anesthesia and meibomian function were examined in turn in the subjects,and lateral eyes with higher tear osmotic pressure were analyzed.The differences in above indexes among the different groups were statistically compared,and the correlations between the osmotic pressure of tear and clinical parameters were assessed.Results The osmotic pressure of tear was (326.46 ±22.66) mOsm/L in the dry eye group,which was significantly higher than (296.60± 10.81) mOsm/L in the normal control group (P＜0.05),and the OSDI scores,TFBUT,corneal fluorescine scores,conjunctival staining scores and S Ⅰ t values in the dry eye group were remarkably elevated in comparison with the normal control group (all at P＜0.05).The osmotic pressure of tear was (341.90 ± 21.15) mOsm/L in the severe dry eye group,which was significantly higher than (310.50±8.99) mOsm/L in the mild and moderate group (P＜0.017).The area under the curve for tear osmolarity in the dry eye group was 0.916,and cutoff value of sensitivity and specificity in dry eye diagnosis was 308 mOsm/L,with the sensitivity value 0.79 and specificity 1.00.The significant correlations were found between the osmotic pressure of tear and OSDI scores,corneal fluorescine scores,conjunctival staining scores and S Ⅰ t outcomes (r=0.338,0.407,0.246,-0.461,all at P＜0.05).However,the osmotic pressure of tear was not correlated with TFBUT (r=-0.113,P＞0.05).Conclusions Tears osmotic pressure might be a useful indicator for the diagnosis of dry eye and assessment of severity.A combined application of tear osmolarity measurement with other relevant indexes can improve the diagnostic value.

Objective To study two different methods in treatment of primary pterygium surgery on corneal epithelial wound repair and the influence on the recurrence rate.Methods Used prospective controlled study,accord-ing to a number table 128 patients with 128 eyes were randomly divided into control group (64 cases),and observa-tion group (64 cases).The two groups of patients underwent pterygium excision and limbal stem cell transplantation. The observation group (64 eyes)received 0.2 mg/mL mitomycin C of mitomycin -C(MMC)adjuvant therapy. Corneal epithelial wound repair speed was observed.The patients were followed up for 6 -12 months,average 8.5months,the recurrence rate of pterygium was observed in the two groups.Results The grafts were smooth,and the conjunctival flap healed well in the two groups.The postoperative corneal epithelial healing time of the control group and the observation group were (2.13 ±0.37)d,(2.87 ±0.41)d,there was statistically significant difference (t =4.91,P <0.01);The postoperative recurrence rates were 6.25%,4.69% respectively,there was no statistically sig-nificant difference (χ2 =0.48,P >0.05).Conclusion There was no difference in recurrence rate between two kinds of pterygium surgical method,but the combined MMC can cause corneal epithelial healing delay.

Aim To investigate the proliferative effect and the apoptosis of rat epididymal epithelial cells induced by podophyllotoxin and its underlying mechanisms.Methods Primary epididymal epithelial cells were cultured in vitro.CCK-8 assay was used to analyze proliferation of epididymal epithelial cells induced by podophyllotoxin on 24, 48 and 72 h.The ultra structural changes of the epididymal epithelial cells were observed by transmission electron microscope.AnnexinV-FITC/PI staining was used to quantify the percentages of apoptosis in the total cell population.The TdTmediated dUTP nick end labeling(TUNEL) technique was applied to observe the morphological changes of apoptotic cells.The expression of tumor necrosis factor alpha(TNF-α) mRNA was investigated by real-time RT-PCR.The level of TNF-α in cell culture supernatant was measured by enzyme-linked immunosorbent assay(ELISA) technology.Western blot was per-formed to determine the protein expression of cytochrome C, caspase-3, caspase-8, caspase-9.Results Podophyllotoxin significantly inhibited the activity of proliferation and induced apoptosis of epididymal epithelial cells in a dose-and time-dependent manner(P<0.05), with a 50％ inhibitory concentration(IC50) value and corresponding 95％ confidence intervals(CI) of 59.36(15.50～227.41), 0.37(0.080～1.70), 0.077(0.017～0.35) μmol·L-1 at 24, 48 and 72 h, respectively.Podophyllotoxin induced cell volume turned round and cell nuclear fragmentation and mitochondrial vacuolation.RT-PCR and ELISA results showed that podophyllotoxin improved the expression of TNF-α mRNA and protein.Western blot results demonstrated that podophyllotoxin activated the protein expression of cytochrome C, caspase-3, caspase-8 and caspase-9.Conclusion Podophyllotoxin can induce rat epididymal epithelial cell apoptosis through both the mitochondria-regulated intrinsic pathway and the TNF receptor-mediated extrinsic pathway.

Objective To summarize the experience in early diagnosis and emergency treatment for combined thoracoabdominal injury (CTI). Methods Clinical data of 58 cases of CTI admitted to our hospital from June 2001 to August 2009 were analyzed retrospectively.All the patients were treated by closed drainage of thoracic cavity,of which 12 cases were treated with thoracotomy,31 with laparotomy,seven with thoracic and abdominal incisions and three with combined thoracoabdominal incision.Internal fixation for long limb bones was performed in 27 cases,spinal laminectomy and pedicle screw fixation in five and amputation in one. Results After operation,six cases were found to have adult respiratory distress syndrome (ARDS) and 12 cases were complicated with multiple organ dysfunction syndrome (MODS).Fifty-three cases were cured and five died. Conclusions CTI based multiple injuries are severe and complicated.CT scan in the early stage plays a significant role in the diagnosis of CTI and closed drainage of thoracic cavity is an important assurance of the security of abdominal operation.Early diagnosis,correct choice of operation procedures and reasonable handling order of injured organs can improve the successful rescue rate for multiple injury patients.

Objective To investigate the correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma.Methods A total of 60 New Zealand white rabbits were enrolled and randomly assigned into the experimental group (48 rabbits) and control group (12 rabbits).In experimental group,the models of traffic-induced injuries were successful made by using self-made small gravity traction colliders.There were nine rabbits with craniocerebral injury combined with damage of liver and spleen,three with four extremity fractures combined with damage of liver and spleen,12 with rib fractures combined with damage of lungs and pleural effusion,11 with epidural hematoma,contusion and laceration of brain as well as fractures of four extremities and pelvis,and nine with multiple fractures.The injuries had met the criteria of multiple severe traumas according to the injury severity score (ISS).The control group had similar condition with experimental group except for participation in injury model.The parameters at time points of 6,12,24 and 48 h after injury were observed.The parameters were:(1)Enzyme linked immunosorbent assay (ELISA) and high pressure liquid chromatography (HPLC) were used to detect the levels of diamine oxidase (DAO) and the ratio of lactulose to mannitol in urine in order to evaluate the permeability of intestinal mucosal barrier.(2) The small intestinal propulsive rate was detected by carbon pushing mcthod.The interstitial cells of Cajal in the snall intestine wall were observed by transmission electron microscopy.The expression of C-kit was detected by Western blot.By these means,the dynamic function of intestinal mucosal barrier was evaluated.(3) The damage degree of intestinal nucosal barrier was evaluated by pathological observation and Chiu score in the end of small intestine and colon.(4)The intestinal bacterial translocation was evaluated by intestinal microflora culture,mesenteric lymph nodes checking as well as translocation examination of liver and spleen.Results (1) The level of DAO plasma and urine lactulose/mannitol ratio at 6 h after injury increased to varied degrees,and reached the peak during 12-24 h,the correlation analysis of which showed that plasma DAO levels were positively correlated with AGI grade at 6,12 and 24 h (r =0.486 3,0.493 3,0.477 6,P ＜ 0.05).The ratio of urinary lactulose/ mannitol excretion was only positively correlated with AGI grade at 6 and 12 h (r =0.478 5,0.497 2,P ＜ 0.05).(2) The gastrointestinal transmission rate in the experimental group was (48.2 ± 5.2) ％,and that of the control group was (60.3 ± 3.0) ％.The gastrointestinal transmission rate of model group rabbits was significantly longer than that of control group (P ＜ 0.05).(3) The interstitial cells of Cajal decreased dramatically during 12-24 h after the injury,and the expression level of C-kit protein decreased consistently with the increase of AGI grade.(4) The intestinal and colonic mucosa tissues of the experimental group showed obvious necrosis at 12-24 h after injury,and the Chiu score increased gradually with the increase of AGI grade under light microscope.(5) The Enterobacter and Enterococcus in the experimental group increased significantly compared with that in the control group.But the numbers of Bifidobacterium,Lactobacillus,Lactobacillus,Bacteroides as well as the ratio of Bifidobacterium to Enterobacteriaceae significantly decreased(P ＜0.05).(6)The organ bacterial translocation rates were 24％,42％ and 62％ after injury in experimental group (P ＜0.05).Conclusions Acute gastrointestinal injury may occur early after severe multiple trauma,and the injury severity is closely related to the change of intestinal barrier function and bacterial translocation.Early attention and active correction of the change of intestinal microenvironment are of great importance for treatment of multiple trauma.