Objective:To investigate esomeprazole combined with early enteral nutrition on the immune function and intestinal flo-ra in the elderly by patients with severe acute pancreatitis. Methods:Totally 78 elderly by patients with severe acute pancreatitis were selected and randomly divided into the observation group (39 cases) and the control group (39 cases). The control group was treated with early enteral nutrition therapy, and the observation group was treated with esomeprazole additionally. The treatment course was 14 days. Results:The total effective rate of the observation group was higher that of the control group (P<0. 05). The abdominal pain relief time, recovery time of bowel sounds, abdominal distension relief time, and the time of serum amylase returning to normal and u-rine amylase returning to normal in the observation group were all better than those in the control group (P<0. 05). The incidence of intestinal flora disorders in the observation group was lower than that in the control group (P<0. 05). After the treatment, CD3+, CD4+ and CD4+/CD8+ increased in both groups (P<0. 05), and those in the observation group were higher than those in the con-trol group (P<0. 05). Serum amylase and urine amylase decreased in both groups after the treatment (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). No serious adverse drug reactions appeared in both groups. Conclusion:Esomeprazole combined with early enteral nutrition in the elderly by patients with severe acute pancreatitis shows significant effect, and the effect may be related with improving the immune function and intestinal flora.

Background Bevacizumab and triamcinolone acetonide (TA) has been widely used in the treatment of diabetic macular edema (DME) clinically,but the effectiveness of both treatment has disadvantage.Therefore,some researchers try to combine bevacizumab with TA for the management of DME,but its efficacy is controversial.Objective This study was to evaluate the efficacy and safety of intraovitreal injection of bevacizumab combined with TA versus bevacizumab for DME.Methods The randomized controlled trials (RCTs) of bevacizumab combined with TA versus bevacizumab via intraovitreal injection for DME were searched from Pubmed,EMbase,Cochrane Library,CNKI.The methodological quality of the literature was evaluated according to evidencebased medicine (EBM),and the quality of the RCTs was appraised based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.The outcome indicators including the change values of central macular thickness (CMT) and best-corrected visual acuity (BCVA) as well as the safety indicators including topical and system adverse response of RCTs were analyzed with Cochrane Collaboration' s software RevMan 5.0.Results Nine RCTs were included with 665 eyes.The decrease value of CMT was more remarkable in the bevacizumab combined with TA group than that of the only bevacizumab group 12 weeks and 18 weeks after intravitreal injection (WMD =-44.69,95％ CI:25.27-64.11,P ＜ 0.000 001 ; WMD =-66.86,95％ CI:40.67-93.05,P ＜ 0.000 001).However,no significant differences were found in the change value of CMT in 6 weeks and 6 months after injection between the two groups (WMD =-15.40,95％ CI:-4.04-34.85,P =0.12 ; WMD =-2.57,95％ CI:-19.62-24.75,P =0.82).The improvement value of BCVA (LogMAR) in the bevacizumab combined with TA group was superior to that of the only bevacizumab group 6 weeks after injection (WMD =-0.04,95 ％ CI:-0.08--0.00,P =0.05),but there were no significant differences between the two groups at 12weeks,18 weeks and 6 months after treatment (WMD =-0.04,95％ CI:-0.12-0.05,P=0.36;WMD =-0.04,95％ CI:-0.11-0.03,P=0.28; WMD =0.03,95％ CI:-0.05-0.12,P=0.45).The incidence rate of transient anterior response after injection was not significantly different between the two groups (RR =0.89,95％ CI:0.49-1.60,P =0.70).Secondary ocular hypertension after injection occurred in 30 eyes in the bevacizumab combined with TA group,but no hypertension was seen in the only bevacizumab group.Conclusions Compared with only bevacizumab,intravitreal injection of bevacizumab combined with TA has a better efficacy in improving CMT but no obvious dominant in increasing BCVA for early DME.Intravitreal injection of bevacizumab combined with TA seemingly has a higher risk of inducing controllable ocular hypertension than administration of only bevacizumab.

Idiopathic macular hole after the internal limiting membrane (ILM) is removed during surgery, the intraoperative optical coherence tomography can be used to observe the presence of debris tissue (RF) protruding into the vitreous cavity at the edge of the hole. Current studies suggest that RF may be caused by epiretinal proliferation and vitreomacular traction, but it is still controversial, and the influence of postoperative anatomical and functional recovery is not clear. Common points can still be found, some of the studies suggest that RF is not conducive to postoperative anatomical and functional recovery during the operation, ILM fragments remain on RF tissues after ILM peeling and re-staining. However, in some studies suggest that RF is beneficial to postoperative anatomical and functional recovery, and ILM fragments on RF are removed. This suggests that whether ILM is removed on RF lead to a certain influence on the postoperative efficacy. There are few researches on RF at present, so it is necessary to understand RF from its essence and assist judgment through histological analysis.

Objective:To define the expression levels of MDM2 gene in nasopharyngeal carcinoma (NPC)and its relationship with p53 protein expression and EB virus latent infection. Method :MDM2 gene expression atmRNA and protein levels,p53 protein and EB virus DNA were detected by nonradioactive in situ hybridization(ISH) ,immunohistochemistry(IHC) and polymerase chain reaction (PCR) separately in 46 cases of NPC tissuesand 12 cases of chronic inflammation of nasopharyngeal epithelium (CINE). Result: Fourteen cases of NPCshowed MDM2 mRNA and protein overexpression, 38 cases were p53 protein positive,and 43 cases were EBV-DNA positive. Neither MDM2 nor p53 protein was expressed in any case of CINE. MDM2 expression was signifi-cantly related to p53 protein expression ( P ＜0. 05), but not to EB virus latent infection in NPC. Conclusion:MDM2 gene may play an important role in the pathogenesis of NPC through interacting with p53 protein.

Objective To observe the foveal contour characteristic of idiopathic epiretinal membrane (iERM).Methods A total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study.All eyes received the examination of optical coherence tomography (OCT) and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA).Foveal contour grading was according to the ratio of central macular thickness (CMT) to the thickness of the retina 1 mm away on OCT line scan:Grade 0,depressed;Grade 1,flat;Grade 2,elevated.Baseline foveal contour grade was as follows:28 eyes with Grade 1 (Group 1),and 25 eyes with Grade 2 (Group 2).The mean logMAR BCVA was 0.40±0.26 in Group 1,and 0.60±0.27 in Group 2 respectively.The mean CMT was (433.52± 133.05) μm and (571.70± 85.40) μm respectively.The logMAR BCVA and CMT both demonstrated significant difference between the two groups (t=-2.825,-4.512;P＜0.05).OCT images and BCVA at 1,3 months after surgery were collected and analyzed.The change in foveal contour,BCVA and CMT were evaluated.The relationship between surgical outcome and different preoperative grading was analyzed.Results Foveal contour grade at 3 months after surgery was as follows:15 eyes with Grade 0,21 eyes with Grade 1,and 17 eyes with Grade 2,demonstrating significant difference compared with baseline (Z=-3.588,P＜0.05).In Group 1,there were 12 eyes with Grade 0,10 eyes with Grade 1,and 6 eyes with Grade 2 postoperatively.In Group 2,there were 3 eyes with Grade 0,11 eyes with Grade 1,and 11 eyes with Grade 2 postoperatively.The postoperative foveal contour grade was significantly different between the two groups (Z=-2.466,P＜0.05).The logMAR BCVA at 1,3 months after surgery both improved significantly compared with baseline (P＜0.05) in Group 1 (t=3.226,5.439) and Group 2 (t=-4.137,5.919).The logMAR BCVA at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.231,-2.291;P＜0.05).The CMT decreased significantly at 1,3 months after surgery in Group 1 (t=-2.674,4.090) and Group 2 (t=-9.663,-9.865) compared with baseline (P＜0.05).TheCMT at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.825,-3.003;P＜0.05).The improvement of logMAR BCVA 3 months after surgery was negatively correlated (P＜0.05) with preoperative logMAR BCVA (r=— 0.758) and preoperative CMT (r 0.359).Conclusion In iERM eyes,flat foveal contour had better surgical prognosis than elevated ones.

Objective To observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreous retinal surgery and the influencing factors of the imaging quality.Methods A retrospective case study.A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital.All the subjects were taken vitreous retinal surgery and iOCT scanning.The patients included 46 males and 86 females,with an average age of 61.7 years.111 cases had macular diseases and 21 cases had vitreous hemorrhage.Cases are divided into high myopia and non high myopia group according to ocular axial length (AL),28 eyes in high myopia group (AL≥26 mm),104 eyes in non-high myopia (AL＜26 mm).The scanning time,image quality and eye conditions were observed during the operation.The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed.Results The iOCT images were identified in 124 of 132 subjects,while were not identified in 8 eyes.For the macular area morphology change,iOCT tips and surgeon judgment rate was inconsistent in 22 eyes (16.7％).For the operation guidance value,change the operation rate of 12/132,accounted for 9.1％.The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups (x2-17.13,P=0.001).Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups (r =3.75,6.18;P 0.049,0.013).There were no complications such as endophthalmitis.Conclusions The surgeon can observe morphological changes in the macular area through iOCT which is difficult to be observed by operating microscope and selected reasonable operation method during the surgery.High myopia,corneal edema and operation time affect the image quality.

Objective:To evaluate the efficacy and safety of conbercept in patients with choroidal neovascularization secondary to chronic central serous chorioretinopathy (CSC-CNV).Methods:A retrospective case study was performed.The medical records of 13 patients (14 eyes) diagnosed as chronic CSC-CNV in Hangzhou Branch of Eye Hospital of Wenzhou Medical University from September 2015 to January 2018 were collected.All the study eyes received intravitreal injection of conbercept (0.05 ml/0.5 mg) under one intravitreal injection and pro re nata (PRN) treatment.The best corrected visual acuity (BCVA) and central macular thickness (CMT) before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were measured and analyzed.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient before initial injection.The study protocol was approved by the Ethics Committee of Hangzhou Branch of Eye Hospital of Wenzhou Medical University (No.2019-029-K-28).Results:During the 6-month follow-up, the mean administration times was 1.93±0.83, and all the CNV secondary to CSC did not grow outside the retinal pigment epithelium layer.The BCVA values before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were 0.51±0.32, 0.43±0.34, 0.36±0.35, 0.31±0.28, 0.27±0.29 and 0.26±0.30, respectively, with a significant difference among different time points ( F=21.225, P<0.05). The BCVA values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). The CMT values before initial injection and 1 week and 1 month, 2, 3, 6 months after initial injection were (299.07±132.90), (216.50±70.94), (203.00±61.87), (234.29±95.70), (194.21±46.46) and (207.43±55.46) μm, respectively, and the difference was statistically significant among different time points ( F=3.768, P<0.05). The CMT values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). No severe treatment complications were observed during the follow-up period. Conclusions:Intravitreal injection of conbercept is safe and can effectively reduce the CMT and improve BCVA of chronic CSC-CNV patients in the short term.

Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.

Objective: To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole. Methods: A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed. Results: In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ²=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631). Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.

Objective:To explore the effects and mechanism of Salvianolic acid B(SalB)on Parkinson's disease(PD).Methods:Forty-eight C57BL/6 male mice were randomly separated into control group(control)withoutdrugs,model group(MPTP)with intraperitoneal injection of 1-methyl-4-phenyl-1,2,3,6-tetrah-ydropyridine(MPTP),SalB control group with intraperitoneal injection of SalB,and SalB treatment group(MPTP+SalB).Construction of PD mouse model by intraperitoneal injection of MPTP,and treatment with intraperitoneal injection of SalB.Pole climbing test was applied to assess behavior differences.The time of first black stool excretion and water content of feces were measured to evaluate intestinal dysfunctions.The number of tyrosine hydroxylase(TH)positive cells in substantia nigra and the level of Toll like receptor 4(TLR4)in colon were analyzed by immunohistochemistry.The pathological changes of colonic mucosa were observed by HE staining.The levels of calprotectin(CP)and tumor necrosis factor-α(TNF-α)in colon were determined by ELISA.Western blot was used to determine the level of TH in midbrain,the protein level of TH,tight junction protein(ZO-1),and protein level of TLR4/MyD88/NF-κB signaling pathways which express in colon.Results:Com-pared with the Control group,the climbing time,T-turn time and the first black stool excretion time in MPTP group increased while the fecal water content and the number of TH positive cells in substantia nigra were decreased.Accompanied by TLR4 positive cells in colon,pathological injury score of colonic mucosa,levels of CP and TNF-α in colon increased,expression of TH in midbrain and expression of ZO-1 in colon decreased.Expressions of TLR4,MyD88,Nuclear NF-κB p65 and p-NF-κB p65 in colon increased.Com-pared with MPTP group,SalB treatment shortened the climbing time,T-turn time and the first black stool excretion time in SalB treat-ment group,increased the fecal water content and the number of TH positive cells in substantia nigra,lowered TLR4 positive cells in colon,enhanced expression of TH in midbrain and colon,reduced the pathological injury score of colonic mucosa,significantly decreased levels of CP and TNF-α in colon,enhanced expression of ZO-1 in colon,inhibited expressions of TLR4,MyD88,Nuclear NF-κB p65 and p-NF-κB p65 in colon.Conclusion:SalB can protect the nerves and intestines and alleviate the intestinal inflamma-tion of PD mice,which may be related to the inhibition of TLR4/MyD88/NF-κB signal pathway.