Background C57BL/6.NOD-Aec1Aec2 mouse is considered to be an idea model for the study of the pathogenesis of Sj(o)gren syndrome,but the cause of dry eye in these mice is unclear.Objective This study was to investigate the histopathological change of the ocular surfaces of C57BL/6.NOD-Aec1Aec2 mice,and to determine whether dry eye is developed spontaneously in these mice.Methods Forty-five clean C57BL/6.NOD-Aec1 Aec2 mice were used as the experiment group and forty-five C57BL/6J mice(both male and female)were used as the control group in this study.Detection of fasting blood-glucose,Schirmer' s test Ⅰ (S Ⅰ t),lissamine green staining and scoring of the corneal and conjunctival epithelium in the mice were performed at the age of 4,8,12,16 and 20weeks.Five mice from each group were sacrificed and their corneas were obtained to measure the central corneal epithelium thickness and to count the number of conjunctival goblet cells.In addition,lymphocyte infiltration in the lacrimal gland of the mice was examined with hematoxylin-eosin staining.The uhrastructure of the corneal epithelial cells and microvilli were assessed by scanning electron microscopy.The use and care of the mice were approved by the Experimental Animal Care Committee of the Third Military Medical University.Results No sign of dry eye was seen in both the 4-week-old C57BL/6.NOD-Aec1Aec2 mice and 4-week-old C57BL/6J mice.The S Ⅰ t values in 8-week-old,12-week-old,16-week-old and 20 week-old mice from the experiment group were (2.7 ±0.9) mm,(2.5 ±0.8) mm,(1.8±0.6) mm and (1.9± 0.1) mm,respectively,showing a significant reduction in comparison with those of the control mice of the same age(all P＜0.01).The amount of lissamine green staining in the C57BL/6.NOD-Aec1Aec2 mice gradually increased with age,showing elevated scores in 12-week-old,16-week-old and 20-week-old mice in the experiment group(all P＜0.01).The central corneal epithelium thicknesses were(20.18±3.75)μm,(17.01 ±5.25) μm,(14.19±5.72) μm and(12.00±3.25) μm in the 8-week-old,12-week-old,16-week-old and 20-week-old C57BL/6.NOD-Aec1Aec2 mice,respectively,which were significantly lower than those of the C57BL/6Jmice of the same age (all P＜0.01).The numbers of conjunctival goblet cells were (8.2±2.4),(6.2±2.1),(6.1 ±2.2) and (4.1 ± 2.0) in the 8-week-old,12-week-old,16-week-old and 20-week-old C57 BL/6.NOD-Aec 1Aec2 mice,respectively,showing a gradual decrease with age and a significant decline in comparison with those of the C57BL/6Jmice of the same age(all P＜0.01).Lymphocyte infiltration in the lacrimal gland and destruction of gland ducts were seen by hematoxylin-eosin staining,and acinar abnormality aggravated with aging.Reduction of corneal epithelial cells and the number of microvilli were distinguished with aging under the scanning electron microscope.The fasting bloodglucose levels of the two groups were both less than 6.0 mmol/L,and no significant difference was found between them at any age(P=0.637,0.610,0.163,0.086,0.938).Conclusions C57BL/6.NOD-Aec1Aec2 mice develop dry eye spontaneously with aging.The course of disease and characteristics of dry eye in C57BL/6.NOD-Aec1Aec2mice is similar to human dry eye.The C57BL/6NOD-Aec1 Aec2 mouse is the perfect model to study the pathogenesis of dry eye.

Acupuncture Therapy ; Attention ; Child, Preschool ; Down Syndrome ; physiopathology ; psychology ; therapy ; Humans ; Language ; Male ; Walking

Objective To explore the safety and effectiveness of transurethral resection of the prostate (TURP) for large benign prostatic hyperplasia.Methods A total of 56 cases of patients with large benign prostatic hyperplasia were analyzed retrospectively.Results The weight of prostate tissue resected with TURP was 60.2 g (48-122 g).The resection rate was 60％,operation time 113.4 min (70-180 min).The lower urinary tract symptoms (LUTS) after TURP was improved significantly.The international prostate symptom scores (IPSS) of 38 cases were decreased from (25.6±1.5) before operation to (6.0± 2.0) after operation.The maximum urine flow rate were increased from (5.0±1.9) ml/s to (18.0±4.5) ml/s.The mean residual urine volume of 22 cases were reduced from 95 ml (40-250 ml) to 10 ml (0-60 ml).Conclusions Skilled TURP technology for large benign prostatic hyperplasia is a safe treatment with good effect and low complications rates.

Family engagement should be part of a holistic management of any patient. This is especially so in patients who have an acute change in their health condition or function that stresses their social setup. Conducting a family conference is one of the many ways to engage patients and their caregivers and address their bio-psycho-social needs. It is a focused and purposeful approach that engages every member of the health care team and family members in facilitating a common understanding and decision-making with the aim of improving patient care and outcome. A family conference is resource intensive, and should be planned well to maximise the goals that it was set out to achieve. This article was written as a primer to help family physicians understand the indications, preparations needed, and steps to take in conducting a family conference. To facilitate a family conference confidently is a skill and an art that requires practice and constant refinement.

BACKGROUND: Insulin resistance and impaired insulin secretion are the key complications of polycystic ovary syndrome (PCOS). The incidences of insulin resistance syndrome (IRS), impaired glucose tolerance (IGT) and diabetes mellitus have been clearly shown to be race-related, thus the association between polycystic ovary syndrome and insulin resistance was race-related.OBJECTIVE: To analyze the correlation of insulin resistance with body mass index (BMI), blood lipids and plasma glucose in Tibetan patients with PCOS.DESIGN: A prospective study based on Tibetan population.SETTING: Department of Cardiology, General Hospital of Chinese PLA; Second Department of Internal Medicine,General Hospital of Tibetan Military Area Command of Chinese PLA.PARTICIPANTS: Thirty-six Tibetan PCOS patients, aged 25-42 years with a mean age of (32±5) years were selected from the Second Department of Internal Medicine and Department of Gynecology, General Hospital of Tibetan Military Area Command of Chinese PLA. Another 36 female inpatients were selected as the controls (control group), aged 24-35 years with a mean age of (30±5) years.METHODS: The disease histories were collected and general conditions were recorded. Oral glucose tolerance test (OGTT, 75 g) was conducted for all the subjects. All the subjects werefasted for 12 hours to collect venous blood samples to detect the levels of hormone, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Ovary was detected with echocardiography. The insulin resistance index was calculated by the homeostasis model assessment (HOMA-IR) was calculated by the formula:fasting insulin (mlU/L)×FPG (mmol/L)/22.5. The blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were compared between the PCOS group and control group.MAIN OUTCOME MEASURES: Blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were observed in both groups.RESULTS: All the 36 PCOS patients and 36 controls were involved in the analysis of final results. ① The BMI, systolic blood pressure and diastolic blood pressure in the PCOS group were higher than those in the control group (t =3.426 5,2.448 4, 2.212 5, P ＜ 0.05-0.01). ② The levels of total cholesterol, triglyceride and LDL-C in the PCOS group were higher than those in the control group (t=2.104 9, t =2.304 7, 2.400 0, P＜ 0.05-0.01), whereas the level of HDL-C was lower that in the control group (t =4.800 0, P＜ 0.01). ③ The levels of fasting insulin and 2-hour plasma glucose and HOM in the PCOS group were higher than those in the control group (t =7.809 5, 12.365 0, 2.789 9, P＜ 0.01).CONCLUSION: Tibetan PCOS patients present a clustering of atherosclerotic risk factors, including obesity, adverse lipid profile, hypertension, hyperglycemia, etc.

Objective To identify risk factors of lymph node metastasis in superficial esophageal squamous cell carcinoma (ESCC),and to provide evidence for treatment choice under endoscope.Methods From January 2007 to December 2011,285 patients with pathologically diagnosed ESCC who received surgery and had clear record of lymph nodes resection were enrolled.The clinical pathological data of these patients were analyzed,including age,gender,smoking and drinking history,history of cancer,family history of cancer,location,tumor size,presence of esophageal,depth of infiltration,differentiation,and vascular cancer embolus.Univariate analysis (chi square test or Fisher exact probability method) and multivariate Logistic regression analysis were performed for risk factors of lymph node metastasis assessment.According to the rates of lymph node metastasis,patients were divided into three groups as follows:low risk,high risk and extremely high risk of lymph node metastasis.KaplanMeier method was used to calculate the average survival time and cumulative five years survival rate.Results Among the 285 patients with ESCC,40 (14.0 ％) patients with lymph node metastasis.The results of univariate analysis showed that location (x2 =9.333),tumor length (Fisher exact probability method),depth of infiltration (x2 =9.327),differentiation degree (Fisher exact probability method) vascular cancer embolus (Fisher exact probability method) were significantly associated with lymph node metastasis (all P＜0.05).The results of multivariate analysis indicated that tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus were independent risk factors of lymph node metastasis,and the odd ratio was 17.408(95％ confidence interval (CI) 1.557 to 194.686),3.471(95％CI 1.440 to 8.365) and 6.256(95％CI 1.787 to 21.910),respectively.The lymph node metastasis rates of patients in low risk,high risk and extremely high risk group were 5.2％(6/115),15.8％ (24/152) and 10/18,respectively;the average survival times were (69.9 ± 2.4),(63.8 ± 2.1) and (51.7 ± 1.7) months,respectively.The cumulative five years survival rates were 59 ％,51 ％ and 31％,respectively,and the difference was statistically significant (x2 6.816,P=0.033).Conclusions The risk of lymph node metastasis is high in ESCC patients with tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus,and the prognosis is poor.Lymph node metastasis should be considered when endoscopic therapy is chosen.

Objective To investigate the effects of chin lift on the patency of upper airway in normal conscious adults using magnetic resonance imaging (MRI).Methods Sixteen healthy volunteers aged 21-35 yr with a body mass index of 17-26 kg/m2 were enrolled in this study.The subjects lay on their back with their heads slightly extended.The lower jaw was first left in standard position.The mouth was slightly open (the distance between the upper and lower incisors was 0.5 cm).The chin was then lifted upward.The upper airway (from the base of slull to the level of vocal cord) was scaned by MRI along the median sagital plane.The length of soft palate,root of tongue and epiglottis and the area of pharyngeal cavity were measured.The position of the rim of epiglottis was examined.The mean percentage changes induced by chin lift were calculated.Results Compared with standard position,chin lift significantly prolonged the length of soft palate,root of tongue and epiglottis and increased the area of pharyngeal cavity.The percentage change in the position of the rim of epiglottis was largest after chin lift.Conclusion Chin lift significantly improve the patency of the upper airway in conscious adult by changing the position of the rim of epiglottis and increasing the area of pharyngeal cavity.

Objective To observe the efficacy of electroacupuncture(EA) on the acupoint combination of He-(sea) points, front-mu points, and shu-points(abbrev. He-Mu-Shu) for the treatment of functional diarrhea, and to explore the effect of He-Mu-Shu point combination EA on the anxiety of patients. Methods A randomized controlled clinical trial was performed in 62 functional diarrhea patients. All of the patients were randomly divided into He-Mu-Shu group(32 cases) and medicine group(30 cases). He-Mu-Shu group was treated with EA on unilateral Quchi, Shangjuxu, Tianshu, Dachangshu point alternatively, and medicine group was treated with oral use of Loperamide hydrochloride capsules. Both groups were treated for 4 continuous weeks. Defecation frequency, stool property and anxiety scores were observed before treatment and 2, 4 weeks after treatment. Results After treatment, weekly defecation frequency, stool property and anxiety scores were improved in both groups, and the differences were statistically significant compared with those before treatment(P < 0.05). He-Mu-Shu point combination EA had better effect on improving weekly defecation frequency, stool property and anxiety scores of functional diarrhea patients than Loperamide hydrochloride capsules, and the differences were statistically significant (P < 0.05). Conclusion The clinical efficacy and anxiety-relief action of He-Mu-Shu point combination EA on functional diarrhea are superior to oral use of Loperamide hydrochloride capsules.

Background: There is lack of normality data in the literature on the plantar response. Objective: To determine the variability of plantar response in normal population and factors that might contribute to the variability. Methods: We conducted a study of plantar response in healthy subjects aged 19-21 in two phases. First phase was plantar examination with hard strike. Subjects with big toe extension in the fi rst phase were re-examined with light and hard strike in the second phase. Results: 100 subjects recruited in fi rst phase, 19 subjects in second phase. Out of 600 attempts (3 attempts for each foot) with hard strike, responses of the big toe were fl exion (48.3%), extension (11.3%), no movement (39.8%); other toes were fl exion (55.0%), extension (13.0%), no movement (32.0%); ankle was dorsifl exion (30.8%), no movement (59.3%); knee were fl exion (15.7%), no movement (84.3%); hip were fl exion (15.2%), no movement (84.8%). Of those with big toe extension, signifi cantly less had persistent big toe extension with light strike. More (41%) among those with extensor big toe has withdrawal response (with fl exion of the hip and knee) as compared to those with fl exor big toe (18.5%, p<0.05). Interfoot asymmetry was seen in 27% (kappa 0.54). Plantar responses of sequential strikes were mostly consistent, with only 3.5% inter-attempt variability. Conclusion: Plantar response with extensor great toe is seen in about 10% of normal adults, less with lighter strike. Withdrawal response can be a partial explanation to the big toe extensor response in normal adults.

Objective To evaluate the multi-spiral CT(MSCT)imaging features and classification of renal pelvis carcinoma.Meth-ods 76 patients of renal pelvis carcinoma proved pathologically were analyzed retrospectively,and divided into different types ac-cording to the MSCT features.The MSCT differences for different types were analyzed.Results Most of the tumors showed iso-density or slight hyperdensity (95%)on un-enhanced images,and persistent mild-to-moderate enhancement (91%)in enhanced im-ages.All cases were divided into three types:pelvic mass type in 30 cases (39%),substance invasion type in 25 cases (33%),wall thickening type in 21 cases (28%).All cases were also divided into two types:substance invasion type(25 cases,33%)and renal pelvis type(5 1 cases,67%).The occurrence rate of local low enhancement,whole kidney low enhancement,hydronephrosis,lymph node metastasis and vein tumor thrombus were 80%,20%,48%,52%,1 6% in substance invasion type cases,and 4%,42%, 75%,4%,6% in the renal pelvis type cases,respectivily.Conclusion MSCT multiphase enhancement scanning shows important valuation in the diagnosis and classification of renal pelvis carcinoma.Obvious differences of CT features are showed for different types.The diagnosis accuracy may be improved by the knowledge of substance invasion type.