Nonresolving inflammation plays an important role in the onset and development of various diseases.Diabetic retinopathy (DR) is a low-degree chronic inflammatory process,and actually it would be a nonresolving inflammatory disease.Failure of neutrophils apoptosis in time,converting failure of macrophages from a pro-inflammatory to anti-inflammatory phenotype,dysfunction of pericytes and poor activation of Thl cells are all contributed to inflammatory prolong.Meanwhile the low concentration of anti-inflammatory soluble factors such as interleukin-10 (IL-10),transforming growth factor-β (TGF-β),nitric oxide (NO),epoxyeicosatrienoic acids (EETs)and lipoxins in serum or ocular specimen are also benefit to failure of inflammatory resolution.In addition,persistent stimulation such as lipid products,advanced glycation end products(AGEs) and reactive oxygen intermediate (ROI)deteriorate the inflammation persistently.More understanding of DR pathogenesis greatly complicates the development of anti-inflammatory therapy.

The major pathogenic bacterium of catheter-related bloodstream infection is gram-positive bacteria.The occurrence of catheter-related bloodstream infection is related with exogenous factors and endogenous factors.It is suggested that catheter-related bloodstream infection should be diagnosed without removing the catheter.It is shown that the catheter should be removed and the patient should use antibiotics as soon as possible if catheter-related bloodstream infection occurred.Buliding a detection system,using antimicrobial dressings and antimicrobial central catheters,and improving patient's nutritional status can decrease the morbidity of catheter-related bloodstream infection.The authors summarize the epidemiology,diagnosis,treatment and prevention strategies of catheter-related bloodstream infection.

Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics.Refractory macular hole includes unclosed MH,reopening MH,large MH,high myopic MH,traumatic MH and secondary MH.Some modified surgeries were employed to improve the surgical results.Inverted internal limiting membrane flap,autologous transplantation of the internal limiting membrane,laser photocoagulation,extended internal limiting membrane peeling,arcuate retinotomy,lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially.Loosening MH traction,providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.

Diabetes mellitus is a systemic and chronic disease induced by abnormal carbohydrate metabolism,and hyperglycemia,hyperlipidemia and hypertension are main clinical characteristics.Long-term high blood glucose level causes the disorders of microvessels and macrovessels in human tissue and organ,resulting in serious complications and extremely high morbidity and mortality worldwide.Diabetes mellitus increases the risk of eye complications,and the incidence of diabetic eye complications is gradually increased in recent years,which is one of important problems that should not be ignored.Diabetic ocular complications include diabetic retinopathy (DR),diabetic optic neuropathy (DN),glaucoma,cataracts,diabetic ocular surface diseases,etc.So the prevention,early diagnosis and effective management for diabetic eye diseases are challenges.Ophthalmologists should pay more attention to diabetic ocular complications and keep a watchful eye on the renewal of managing guidelines of diabetic eye diseases to reduce the blinding rate and economic cost by early detection and timely treatment.

There are many topics in clinical studies of diabetic retinopathy (DR).The current hot topics include the relationship between DR and systemic diseases,major factors for initiation and progression of DR,early DR screening strategies,DR prevention strategies and how to improve the therapeutic effects of DR.However,due to the complexity of DR pathogenesis,multiple risk factors,long cycle of DR prevention and control,it is difficult to exclude all the confounding factors in the DR clinical research.From the long-term perspective,delaying the occurrence and progression of DR and establishing an efficient and practical prevention and control system is the focus of the future DR research in China.

Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients' psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound (IOUS) examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma (n=88) , resection of the body and tail of pancreass (n = 44) , pancreaticoduodenectomy (n=2) , and biopsy (n=1). The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.

Objective To survey the prevalence, distribution of non-motor symptoms (NMS) in essential tremor (ET) and the relationship with disease severity and duration.Methods Fahn-Tolosa-Matin Tremor Rating Scale (TRS) was used to assess motor symptoms in 62 patients with ET.The Parkinson's disease (PD) NMS Questionnaire and T&T olfacmeter and Mini-mental State Examination (MMSE) were used to explore non-motor symptoms in ET patients.Results In ET, a range of NMS occurred across all disease stages.More than half patients (51.6%, 32/62) had olfactory dysfunction,significantly higher than the healthy control group (30.0%, 18/60, x~2=12.371, P<0.05).A third had hyposmia.16.1% had partial olfactory loss.Each ET patient had 5 different NMS on average.Seven NMS were more common in ET patients than in control, including remembering, olfactory dysfunction, intense vivid dreams, anhedonia, depression, anxiety, sleep disorders.The incidences of remembering, olfactory dysfunction,intense vivid dreams were 58.1% (36/62),51.6% (32/62),48.4% (30/62), ranked top 3 in ET patients.Olfaction had inverse correlation with age, while there was a negative correlation between NMS score and TRS score, gender, disease duration and weather to be treated.Conclusion Besides posture tremor and kinetic tremor,NMS occur in ET,and should be well recognized and treated.

Objective To study the incidence of depression in essential tremor (ET) and associated factors. Methods Depression in 62 ET patients and 60 healthy subjects as control was evaluated by means of Hamilton Depression Scale ( HAMD ) , as well as Fahn-Tolosa-Marin Tremor Rating Scale (TRS) and Pittsburgh Sleep Quality Index (PSQI). Results Fifty-three point two percent(33/62) of ET patients and 11.7% (7/60) of healthy subjects were found to have at least mildly depression (HAMD score of 8 or higher), 35. 5% (22/62) of ET patients and 8. 3% (5/60) of healthy subjects fell into the mildly-to-mederately depression (HAMD score between 8 and 20 ), 17.7% (11/62) of ET patients and 3.3% (2/60) of healthy subjects were classified into moderately-to-severely depressed range (HAMD score between 21 and 35). There were statistical differences in ET group and healthy subjects group (X2= 23.898, 13.043, 6.649, all P <0.01). Additionally, there were statistical differences in anxiety/ somatization (t=-6.747, P<0.01), cognitive impairment (t=-2.017, P=0.05), block(t= -4.145, P<0.01), sleep disorders (t=-4.500, P<0.01) and despair (t=-3.591, P<0.01) between depression group and non-depression group. There were marked differences in PSQI total score ( t =-3.196, P=0.003 ), subjective sleep ( F1, t=-3.037, P=0.004), quality sleep latency (F2, t= -4.674, P<0.01) and sleep disturbances (F5, t=-2.594, P=0.013 ) between depression disorder group and non-depression disorder group. Meanwhile, the score of TRS, PSQI and sex were closely correlated with HAMD (β=0.589, P=0.000 ;β=0.469,P=0.000 ;β=0.256, P=0.027 ). Conclusions The incidence of depression is high in ET. Manifestation of depression are anxiety, reduced interest in work, sleep disorders, retardneas, inferiority complex, etc. The degree of symptoms relates to the severity of ET, sleep quality and gender.

ObjectiveTo investigate the risk factors and pathogenic characteristics of catheterrelated infection (CRI) in intensive care unit (ICU),so as to find a better way for its treatment.Methods Retrospective analysis was performed on 247 deep-venous catheter (DVC) from January 2007 to December 2010.ResultsAmong 247 patients,positive results of 41 patients diagnosed CRI,negative results of 206 patients undiagnosed CRI.Compared with undiagnosed CRI patients,found the correlation of the underlying infectious diseases,indwelling time of catheter and puncture sites associated with CRI occurred(P ＜ 0.05 ).CRI major pathogen was gram-positive bacteria (58.5％,24/41 ),in which Staphylococcus epidermis was the major pathogenic bacteria(22.0％,9/41).The drug resistance occurred in most pathogen.Conclusions The occurrence of CRI is related with multiple clinical factors.The gram-positive bacteria is the major pathogen.The etiological monitor should be enforced in patients with DVC.

Objective To summarize the experience in the diagnosis and management of insulinoma. Methods From January 1966 to December 2007, the clinical data of 131 patients with insulinoma were retrospectively analyzed. Results All the 131 cases had Whipple triad syndrome and 64 eases suffered from psychoneurosis symptoms. The fasting blood glucose or insultus blood glucose concentration of all the cases was lower than 2.8 mmol/L. The ratios of serum insulin to glucose were all higher than 0.3. Before operation, tumor was detected in 8 of 75 patients by B-us scan, and in 17 of 68 by CT, and in 5 of 10 by MRI. The intraoperative ultrasonography(IOUS) was applied in 44 eases, and tumor was found in 43 cases. Surgery included enucleation of insulinoma (88 cases), resection of the corpus and eauda of the pancreas (40 cases), duodenopancreatectomy (2 cases), and biopsy (1 case). The low blood glucose symptoms disappeared postoperatively in 130 cases. Pancreatic fistulae occurred in 20 cases, acute pancreatitis occurred in 32 cases. Conclusions Insulinoma can be diagnosed based on symptoms of Whipple triad and the ratio of serum insulin to glucose. Exploration and IOUS are the simple and effective methods to localize insulinoma.