Thyroid associated ophthalmopathy (TAO) is often shown as upper eyelid retraction,conjunctival hyperemia and edema,proptosis,diplopia,strabismus and decreased visual acuity.It is difficult to make a certain diagnosis in the early stage of TAO.Patients suffering from TAO often have upper eyelid retraction at the early stage of disease,which affects appearance and causes feelings of discomfort and decreased visual acuity.Learning more about upper eyelid retraction contributes to the early diagnosis and treatment of TAO.Although upper eyelid retraction with TAO has distinctive manifestations,it is easy to misdiagnose.The differential diagnosis includes congenital eyelid retraction,neurological disorders,high axial myopia,glaucoma filtering bleb,and so on.Family history,clinical manifestations and TAO related examinations should also be taken into consideration.Comprehensive treatments should be adopted.Glucocorticoids and eyelid retraction surgeries are current mainstay of treatment.There are controversies on the application of glucocorticoids about the specific dosage,while agreement achieved that the cumulative dose should not be more than 8 g in one stage in order to reduce the risk of liver failure and other adverse events.Different operation methods should be chosen according to the degrees of retraction and causes of disease for each type of patients.In addition,special attentions should be paid to the decrease of muscle strength in the temporal side.Individual analysis is needed in order to diagnose and treat upper eyelid retraction with TAO.Early diagnosis and intervention can improve the appearance,visual function and quality of life of the patients.

Objective:To establish a new fluorescence-based quantitative PCR assay for detecting hepatitis B virus covalently closed circular DNA(HBV cccDNA).To explore the effect of artificial liver support system(ALSS)on total HBV DNA and HBV cccDNA in sera of patients with fulminant hepatitis B.Methods:The serum specimens from 50 patients of fulminant hepatitis B prior to and after treatment with ALSS were collected.Then HBV cccDNA was quantitatively detected by fluorescent PCR with specific primer set and Taqman probe.And the results were analyzed by SAS8.0 statistics software.Results:We successfully established a new fluorescence-based quantitative PCR method for HBV cccDNA.HBV cccDNA was detectable in sera of the patients with fulminant hepatitis B.The level of total HBV DNA and HBV cccDNA decreased significantly following plasma exchange in ALSS.The levels of total HBV DNA and HBV cccDNA had positive correlation with degree of PT,ALT,andAST.Total HBV DNA also had positive correlation with HBV cccDNA.Conclusion:The level of total HBV DNA and HBV cccDNA has positive correlation with degree of PT,ALT,and AST,which might be indication of hepatocyte damage.The finding that significant decrease in total HBV DNA and HBV cccDNA after plasma exchange in ALSS may provide a clue of further research about the fulminant hepatitis B treated with ALSS.

ObjectiveTo investigate the delayed umbilical cord clamping in preterm children of anemia in premature children.Methods60 preterm children were randomly divided into study group and control group 30 patients in each group.The control group was taken regular off umbilical,the observation group delay 90s(after birth at least 2min) off umbilical.ResultsThe Hb, HCT, and SI in the postnatal 1,2,4,8 weeks were significantly lower than the observation group, the difference was statistically significant (all P ＜ 0.05), and the control group after birth in preterm children Ret in the first week was significantly higher than 2,4 in the observation group, the difference was statistically significant(all P ＜ 0.05) ; The observation group at 6 months the incidence of anemia(13.3％) and transfusion rate(6.7％) were significantly lower than the control group(43.3％ ,33.3％) ,the difference was statistically significant(all P ＜0.01).ConclusionDelyed umbilical cord clamping in preterm children could increase the redblood cells and iron reserves in preterm children, reduce the incidence of anemia caused by blood transfusion, was worthy of clinical application.

Objective To explore the outcomes of radiotherapy and zoledronic acid in patients with bone metastasis.Methods 48 cancer patients with bone metastasis,were divided into two group,control group received radiotherapy only,therapy group received radiotherapy and zoledronic acid.Remission of ostalgia was evaluated after 3-6 months.Results The total effective of remission of ostalgia had no significant differences between two group(83.3 ％ vs 79.2％,P ＜ 0.05).But rate of complete remission therapy group was higher than that of control group(50.0％ vs 33.3％,P ＜ 0.05).The adverse reaction aer resemble between the two group.Conclusion The outcomes of radiotherapy and zoledronic acid in patients with bone metastasis is effectiveness for cases with bone metastasis,is worth spreading.

Objective To investigate the clinical effects of different dose of remifentanil with double-tube type laryngeal mask airway (LMA) ventilation in the aged patients undergoing total hip-arthroplasty (THA).Methods Sixty ASA class Ⅰ-Ⅱ grade patients undergoing THA were enrolled in the study.The patients were divided into three groups according to remifentanil dose with 20 cases each,0.2 μ g/ (kg· min)group,0.3 μ g/(kg· min) group and 0.4 μ g/(kg· min) group.Heart rate and mean arterial pressure (MAP)were measured immediately before anesthesia induction,immediately after anesthesia induction,immediately after inserting LMA,the set of operation,15 min during operation and discontinuation of anesthetic.Results All patients were successfully operated without intraoperative awareness.In 0.2 μ g/(kg·min) group,the patients suffered from the heart rate and MAP fluctuations,the high incidence of body movement (45.0％,9/20),and the maximum amount of propofol [(82.4 ± 21.6) mg].In 0.3 μg/(kg· min) group,heart rate and MAP had the better fluctuation,and patients might wake up faster postoperatively.In 0.4 μ g/(kg· min) group,heart rate and MAP significantly decreased,the amount of efedrina [(5.2 ± 4.3) mg] was the largest in the three groups,the recovery time [(5.2 ± 1.3) min] was the longest Conclusion Remifentanil 0.3 μg/(kg·min) compound with propofol with double-tube type LMA can be used for total intravenous anesthesia in the elderly patients with THA,with hemodynamic stability,fewer complications,and reliable ventilation.

Objective To compare the effect of ureteroscopic pneumatic lithotripsy(URL) and extracorporeal shock wave lithotripsy(ESWL) for ureteral stones.Methods 90 patients with ureteral stones were randomly divided into group A( URL group),group B( ESWL group),each group 45 cases.The effect of surgical treatment was compared between the two groups.Results The one-time success rate of gravel,stone free after 4 weeks of A group was significantly higher than that of group B( x2 =9.680,5.414,all P ＜0.05),but there was no significant difference in the surgical time and hospital stay of the two groups( t =1.010,0.909,all P ＞ 0.05 ).The postoperative renal colic,fever and other complications of group A were significantly lower than that of group B ( x2 =6.049,5.075,all P ＜0.05),but the gross heraturia and ureteral injury of group A was higher than that of group B(x2 =5.874,3.873,all P ＜ 0.05 ).Conclusion The ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of ureteral stones all have good effect,but ureteroscopic pneumatic lithotripsy and stone rubble drain success rate are significantly higher than extracorporeal shock wave lithotripsy,and postoperative complications are relatively less than extracorporeal shock wave lithotripsy.

Objective To analyze the detection results of blood fat and proinsulin related indicators in the patients with type 2 diabetes mellitus(T2DM ) and to investigate the means for improving the patients′ clinical indicators .Methods 57 patients with T2DM in our hospital from February 2013 to February 2015 were divided into the research group ( ≥ 15 .6 mIU /L ,29 cases) and the control group (< 15 .6 mIU /L ,28 cases) according to the proinsulin level .All the cases took glucose ,at the same time the cor‐relation between the blood fat indexes with serum true insulin ,proinsulin and insulin resistance index of steady state insulin assess‐ment model was analyzed .Results Proinsulin ,serum true insulin ,2 h postprandial proinsulin ,2 h postprandial serum true insulin , insulin resistance index of steady state insulin assessment model all had correlation with and apolipoprotein B /apolipoprotein A1 . Conclusion The proinsulin level in the patients with T 2DM is increased ,thus the ratio of apolipoprotein B/apolipoprotein A1 will be accordingly increased .

OBJECTIVE:To observe the efficacy and safety of methylprednisolone combined with entecavir in the treatment of primary nephrotic syndrome with hepatitis B virus infection. METHODS:23 primary nephrotic syndrome patients with hepatitis B virus infection were given 0.5 mg/times Entecavir tablet,orally,once a day,for 2 weeks,and added 0.8mg/(kg.d)Methylpredniso-lone tablet,orally,once a day,for 8 weeks,then the dose was maintained for 2-3 months every other day,and then decreased 4 mg for 4 weeks every other day,and the dose was decreased 4 mg every 2-4 weeks,until drug withdrawal. Entecavir tablet was used in the whole process of Methylprednisolone tablet,the dose was adjusted and gradually stopped based on HBV-DNA within 3 months of Entecavir tablet withdrawal. Liver and renal efficacy,24 h urine protein excretion,serum albumin(ALB),alanine ami-notransferase(ALT),aspartate aminotransferase(AST)levels before and after treatment of 2,6,12 and 15 months,and the inci-dence of adverse reactions of all patients were observed. RESULTS:The liver and renal efficacy were 100%;after treatment of 2, 6,12 and 15 months,24 h urine protein,ALT and AST were significantly lower than before and gradually decreased by time, ALB was significantly higher than before and gradually increased by time,the differences were statistically significant(P<0.05);the incidence of adverse reactions was 43.48%,and there were no obvious adverse reactions and no renal dysfunction. CONCLU-SIONS:Methylprednisolone combined with entecavir has significant efficacy in the treatment of primary nephrotic syndrome with hepatitis B virus infection,with good safety.