Objective:To observe the flow density (FD) of macular and optic disc and area of foveal avascular zone (FAZ) in severe nonproliferative diabetic retinopathy (S-NPDR).Methods:A prospective cross-sectional study. From October 2019 to April 2020, 31 eyes of 25 S-NPDR patients (S-NPDR group) who were diagnosed in the ophthalmological examination of Jiangsu Province Hospital and 30 eyes of 30 age- and sex-matched healthy volunteers (control group) were included in this study. Optical coherence tomography angiography (OCTA) was used to scan the macular area of 6 mm×6 mm and optic disc of 4.5 mm×4.5 mm. The software automatically divides it into three concentric circles centered on the macular fovea, which were foveal area with a diameter of 1 mm, parafoveal area of 1 to 3 mm, and foveal peripheral area of 3 to 6 mm. The area around the optic disc was divided into 8 areas: nasal upper, nasal lower, inferior nasal, inferior temporal, temporal lower, temporal upper, superior temporal and superior nasal. The FD of the optic disc, the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina and FAZ area were measured. The FD and FAZ area were compared between the two groups by independent sample t test. The correlation between FAZ area and FD was analyzed by Pearson correlation. Results:In parafoveal and perifoveal area, compared with the control group, the FD of SCP ( t=6.470, 5.220; P<0.001) and DCP ( t=7.270, 7.370; P<0.001) decreased in S-NPDR group. In foveal area, there was statistically significant difference in the FD of DCP between the two groups ( t=2.250, P=0.030), while the difference in FD of SCP between the two groups was not statistically significant ( t=0.000, P=0.900). The FAZ area in S-NPDR group was larger than that in control group, and the difference was statistically significant ( t=2.390, P=0.030). The FD in the S-NPDR group was lower than that in the control group except the superior nasal, the difference was statistically significant ( t=7.520, 5.000, 4.870, 3.120, 2.360, 2.120, 5.410, 5.560, 2.640; P<0.05). Pearson correlation analysis showed that the FAZ area of S-NPDR was negatively correlated with FD of SCP ( r=-0.513, P=0.004), and had no correlation with FD of DCP ( r=0.034, P=0.859). Conclusion:The overall FD in macular area and optic disc of patients with S-NPDR decreased and the FAZ area enlarged.

Objective To investigate the intraoperative intraperitoneal chemotherapy security with raltitrexed in advanced colorectal cancer surgical operation.Methods Sixty patients with colorectal cancer undergone surgery were randomly divided into trial group (n =30) and control group (n =30) according to the random number table method.The trial group was given surgical operation plus with intraperitoneal chemotherapy with raltitrexed.The control group was given surgical operation plus with intraperitoneal saline perfusion.Theroutine blood test,liver and kidney functions,toxic side effects and complications in two groups before and after surgery were investigated.Results The white blood cells in trial group before and after surgery was (6.36 ± 2.63) × 109/L vs.(8.20 ± 2.08) × 109/L,with statistically significant difference (t =3.06,P ＜0.05).The ratio of absolute neutrophil count in trial group before and after surgery was 65.17％ ± 10.36％ vs.72.21％ ± 10.53％ (t =3.22,P ＜ 0.05).The platelets in trial group before and after surgery was (261.03 ±84.74) × 109/L vs.(228.47 ± 58.69) × 109/L (t =2.07,P ＜ 0.05).The white blood cells,the ratio of absolute neutrophil count and the platelets after surgery had no statistically significant differeuces between the two groups (P ＞0.05).The trial group had higher 1,2 level vomiting (60.00％ vs.23.33％;x2 =8.30,P ＜ 0.05),and nausea (30.00％ vs.6.67％;x2 =5.46,P ＜ 0.05) incidence rates,but there was no statistically significant difference in other toxic side effects (P ＞ 0.05).The major complications post operation included intestinal obstruction,incision infection,abdominal cavity bleeding,and anastomotic fistula.There were equivalent complications in two groups (6.67％ vs.3.33％,x2 =0.35,P ＞0.05;10.00％ vs.6.67％,x2 =0.22,P＞0.05;0 vs.0;3.33％ vs.0,P＞0.05).Conclusion For patients with advanced colorectal cancer,intraoperative intraperitoneal chemotherapy with raltitrexed is safe and feasible,and the adverse reactions can be tolerated without increasing postoperative complications.

Objective To explore the change of function of adrenal cortex in patients with hyperthyroidism to provide theoretical evidence for clinical practice. Methods The reaction of adrenal cortex to small dosage of ACTH was detected and compared with each other in normal controls,in patients with mild hyperthyroidism,and patients with severe hyperthyroidism. Results The reaction to small dosage of ACTH was statistically different among the three groups \[F=278.3(15 min), 274.2(30 min), 469.8 (60 min), 273.3(min),866.2(AUC),P

Background Choroidal neovascularization (CNV) is one of the primary causes leading to visual damage in many fundus diseases.Many evidences indicate that macrophage activation and monocyte chemoattractant protein-1 (MCP-1) play important roles in CNV.However, the dynamic expression of macrophage and MCP-1 in the initial stage of CNV is not clear.Objective This study was to investigate the dynamic changes of F4/80 and MCP-1 expressions in retina-choroid tissue with experimental CNV.Methods Laser-induced CNV models were monocularly established in 105 SPF 8-week-old male wild type C57BL/6 mice.The mice were sacrificed at 6,12,24, 48 and 72 hours after photocoagulation, respectively, and the retina-choroid tissue sections and choroidal flatmounts were prepared.The histopathological examination was carried out to observe the changes of morphology and structure as well as inflammatory response in CNV.The expression and distribution of F4/80 and MCP-1 protein in retinachoroid were detected by double immunofluorescence technique.The expression and distribution of F4/80 in choroid were examined by immunofluorescence.The relative expression levels of F4/80 mRNA and the content of MCP-1 protein in RPE-choroid complex were assayed using real-time quantitative PCR and ELISA,respectively.The use and care of the mice complied with the Regulation for the Administration of Affair Concerning Experimental Animals by Ethic Committee of Experimental Animals of Nanjing Medical University.Results The rupture of Bruch membrane, RPE, outer nuclear layer and choroid was exhibited under the optical microscope 6 hours after photocoagulation.Infiltration of inflammatory cells and tissue edema were seen as the lapse of photocoagulation time, and proliferation of vascular endothelial cells was found 72 hours after photocoagulation.F4/80 was expressed in photocoagulation area 6 hours later, and MCP-1 was expressed around the area.With the lapse of photocoagulation time,the expression intensity of MCP-1 weakened and that of F4/80 enhanced.The contents of MCP-1 protein in RPE-choroid complex were (31.25±4.73), (276.31 ±4.20), (331.95 ±5.86), (221.24±4.42), (179.89 ± 4.10) and (130.80 ± 5.90) pg/mg in the normal control group, photocoagulation 6-, 12-, 24-, 48-and 72-hour groups, respectively,with a significant difference among the groups (F=1 416.46 ,P＜0.01).The contents of MCP-1 protein peaked at 12 hours after photocoagulation and then gradually declined.The expression levels of MCP-1 protein in different time groups were higher than those in the normal control group (all at P＜0.01).A significant difference in F4/80 mRNA expression in RPE-choroid complex was also found among the groups (F =762.72, P＜0.01, and a gradually raising tendency was seen over time, showing evidently increase in comparison with the normal control group (all at P＜0.01).Conclusions Inflammatory response occurs in the early stage of experimental CNV.MCP-1 responds to the CNV at early stage,and the accumulation and activation of macrophage play an important role in the development of CNV.

Objective To treat axillary osmidrosis by using three procedures (small incision apocrine curettage,cut-off operation and aspiration surgery),to observe the postoperative complications,efficacy and the pathological changes of skin,and to explore the advantages of these three procedures.Methods Seventy-five cases of evere bilateral axillary osmidrosis were involved in this study,totally 150 axillary surgery area,which was randomly divided into different group:Group A (curettage group); Group B (cut-off group) and Group C (aspiration group).Different surgical treatment was conducted in the three groups of operation area.Results Incidence of complications was 28.30 ％ and total effective rate was 94.34 ％ in Group A; in Group B,incidence of complications was 6.38 ％,and total effective rate was 97.87 ％ ; in Group C,incidence of complications was 4.00 ％ and total effective rate was 78.00 ％.The incidence of complications was significantly different between Groups A and B and between Groups A and C,but not significant difference between Groups B and C.The cure rate and efficiency were not significant difference between Groups A and B groups,but significant difference was found between Groups A and C and Groups B and C.HE staining results showed that the dermal tissues were partially destroyed in Group A and B,and no apocrine sweat glands were not seen within the dermis and subcutaneous tissues; in Group C,the dermal tissue was rarely destroyed,and a lot of apocrine sweat glands were reserved within the dermis and subcutaneous tissues.Conclusions Efficacy of curettage and cut-off procedures is better,but that of aspiration is worse in the treatment of axillary asmidrosis.The complications of cut-off surgery and aspiration are less,but urettage has more complications.Therefore,the efficacy of cut-off operation is the best with least complications among the three procedures.

Objective To investigate the difference between simple continued traction and areola dermal flap filling in inverted nipple correction surgery.Methods There were 60 nipples of 32 patients in simple continuous traction group and 62 nipples of 32 patients in dermal flap filling group.Follow-up was conducted for 12 months.The surgical results were compared with statistical analysis.Results Wound healing,nipple shape,blood supply,feeling and breast-feeding function in simple continuous traction group were better than those of the dermal flap filling group.There was no statistically significant difference in diameter and height of nipple,nipple retraction and relapse rate between the two groups.Conclusions Simple continuous traction is superior to dermal flap filling.Both methods are safe and effective for the treatment of various types of inverted nipple and two groups of patients have improved in symptoms and appearance.

Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative dizziness,headache,nausea and vomiting (PONV) in patients undergoing thyroidectomy.Methods One hundred patients (39 males and 61 females,ASA physical status Ⅰ or Ⅱ) scheduled for thyroidectomy were randomly divided into two groups according to random number table: control group (group C) and multimodal-antiemetic therapy group (group M).Two groups received total intravenous anesthesia (TIVA) with propofol and remifentanil.Prophylactic dexamethasone 10 mg were given after anesthesia induction and palonosetron hydrochloride 0.25 mg was used 30 min before the end of surgery in both groups.Mannitol 2 ml/kg in group M and the same amount of normal saline in group C were given 30 min before the end of surgery.The incidence of dizziness,headache and PONV were observed for 24 h in two groups.Results The incidence of headache was 5 cases (10%)and PONV was 5 cases (10%) in group M,which were respectively significantly lower than that of group C of 15 cases (30%) and 12 cases (24%) in 24 h after surgery (P<0.05).The additional antiemetic therapy for 24 h after surgery in group M of 2 cases (4%) was significantly lower than that of group C of 9 cases (18%) (P<0.05).Conclusion The multimodal-antiemetic therapy: prophylactic dexamethasone,palonosetron hydrochloride and mannitol were used 30 min before the end of surgery could significantly reduce the incidence of dizziness,headache and PONV after thyroidectomy.

Objective To assess the prediction value of technetium-99m methoxyisobutylisonitrile(~(99)Tc~m-MIBI) for the effect of chemotherapy in small cell lung cancer (SCLC) patients. Methods Fifty-three patients with SCLC were divided into two groups according to the chest computed tomography (CT) examination, 39 patients in group A with complete or partial remission, and 14 patients in groups B with stable or progressive status. ~(99)Tc~m-MIBI was performed before chemotherapy. Following i. v. administration of 740 MBq ~(99)Tc~m-MIBI, SPECT imagings at 10 -30 minutes (early) and 2 -3 hours (delayed) were performed to obtain the uptake ratio of early phase tumor/normal lung tissue (ER) and the uptake ratio of delayed phase tumor/normal lung tissue (DR). The retention index (RI) was calculated as (DR-ER)/ ER × 100%. The differences of ER,DR and RI between the two groups were tested through t-test and rank sum test. Results ~(99)Tc~m-MIBI uptake was significantly higher in group A than group B: 2.33(SD:0.21) vs 2.02(SD:0.31) for the early ratio (ER) (t = -3.401, P<0.05) and 2.44(SD:0.19) vs 1.86 (SD :0.30) for the delayed ratio (DR) (t = - 6.724,P < 0.05). The median of RI in group A was signifi-cantly higher than that in group B (5.31% vs -9.26%,P <0.05). Conclusions ER,DR and RI of ~(99)Tc~m-MIBI SPECT may be helpful in predicting the response to chemotherapy in patients with SCLC.

Objective To evaluate the efficacy and safety of radiation combined with targeted therapy of EGFR-TKI in the patients with stage IV non-small cell lung cancer ( NSCLC). Methods There were 17 female and 9 male patients with NSCLC enrolled into this study, which included 19 adenocarcinoma, 4 alveolar carcinoma and 3 uncertain carcinoma according to the iconography findings. Sixteen patients suffered from single or multiple bone metastasis,and 10 cases with brain metastasis. Gefitinib 250 mg or Erlotinib ISO mg per day were administrated during and after the process of radiation until the disease progressed. Results All patients had complete combined therapy, 12 of them suffered from diarrhea, 8 from emesia and 12 from erythra. The average score of ECOG improved from 3 to 2 after combined therapy. The bone metastasis control rate was 93.8% ,brain metastasis control rate was 70.0% , and the 6-month local lung lumps control rate was 84. 6%. Conclusion Palliative radiation combined with targeted therapy of EGFR-TKI is an effect and safe therapy for the patients with the stage IV of NSCLC, but the influence on survival shall be observed in further study.

Objective:To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR).Methods:A prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole- retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation.Results:At 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant ( P<0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance ( P<0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant ( P<0.05). There was no significant difference one week after eye operation in control group ( P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant ( P<0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group ( P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant ( P=0.020). Conclusion:PPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.