[ ABSTRACT] AIM:To investigate the effect of hyperbaric oxygen ( HBO) on hypoxia-inducible factor-1α( HIF-1α) expression in rat experimental periodontitis with psychological stress.METHODS:Male special pathogen-free Wistar rats ( n=120) were randomly divided into 4 groups:normal control group;psychological stress stimulation group;experi-mental periodontitis group: the periodontitis model was induced by wrapping 3/0 silk ligature inoculated with Porphy-romonas gingivalis around the left maxillary second molar of the rats;periodontitis model with stress stimulation group.Psy-chological stress was removed at the 9th weeks after ligature, 6 rats from each experiment group were randomly chosen to HBO treatment.The rats were sacrificed at the 2nd, 4th, 8th and 10th weeks after ligature.Gingival index ( GI) and at-tachment loss (AL) were measured before sacrifice.The histological changes of periodontal tissues were observed under microscope with HE staining.The expression of HIF-1αwas observed by the method of immunohistochemistry.RE-SULTS:The sites of gingival attachment were normal in control group and psychological stress stimulation group.Periodon-tal pocket, and periodontal attachment loss were observed in experimental periodontitis group.The tissue damage was much serious in periodontitis model with stress stimulation group.No significant difference of GI and AL among psychological stress stimulation group and normal control group during the experiment was observed.GI and AL in periodonitis model with stress stimulating group were significantly higher than those in experimental periodontitis group at the 4th and 8th weeks (P<0.01).The levels of GI and AL were significantly lower at the 10th weeks after HBO treatmnt than those in untreated groups (P<0.05).No significant difference of HIF-1αexpression scores among psychological stress stimulation group and normal control group was found.HIF-1αexpression scores in periodonitis model with stress stimulating group was signifi-cantly higher than that in experimental periodontitis group at the 4th and 8th weeks (P<0.01).At the 10th weeks after HBO treatment the levels of HIF-1αwere significantly lower than that in untreated groups (P<0.01).CONCLUSION:Stress stimulation may aggravate periodontitis by decreasing tissue oxygenation in rats.HBO may represent a useful way in psychological stress periodontitis therapy.

Objective:To assess the safety and efficacy of riboflavin/ultraviolet-A-induced accelerated epithelium-off corneal collagen cross-linking (CXL) for teenagers with keratoconus.Methods:In this case series study, 25 eyes of 18 patients with primary keratoconus who underwent riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL in Zhengzhou Second People's Hospital from January 2017 to February 2018 were included, and the average age of patients was (14.4±1.3) years.The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), maximum keratometry reading (K max), thinnest corneal thickness (TCT), posterior corneal elevation (PCE) and endothelial cell density (ECD) were measured before and after CXL.The patients were followed up for one year.The complications and adverse reactions were recorded.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Zhengzhou Second People's Hospital (No.KY2017002). Written informed consent was obtained from each patient and their guardian prior to the surgery. Results:The mean UCVA (LogMAR) was 0.96±0.35 at baseline, which was significantly improved to 0.84±0.33 at 1 year postoperatively ( t=-5.765, P<0.01). The mean BCVA (LogMAR) was 0.45±0.22 preoperatively, which was significantly improved to 0.34±0.26 at 1 year postoperatively ( t=-4.843, P<0.01). The mean SE was (8.66±5.11)D at baseline, which was significantly higher than (8.07±5.21)D at 1 year postoperatively ( t=-3.253, P=0.003). The K max was reduced from (58.58±9.07)D preoperatively to (56.25±9.98)D at 1 year postoperatively, with significant difference between the two time points ( t=-4.357, P<0.01). The K max was reduced more than 1 D in 17 eyes (68%), was stable in 6 eyes(24%), and was increased more than 1 D in 2 eyes (8%). The TCT was reduced from (485.0±32.5)μm at baseline to (475.3±35.5)μm at 1 year postoperatively, with significant difference between the two time points ( t=-4.266, P<0.01). The differences of PCE and ECD between preoperative and postoperative 1 year were not statistically significant ( t=1.023, P=0.316; t=-1.424, P=0.167). There was one eye suffering peripheral sterile corneal infiltrate 2 days postoperatively, and favorable prognosis was achieved after the topical steroids application.No complication was encountered in other subjects. Conclusions:Riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL is safe and effective in teenagers with keratoconus during the 1-year follow-up.The long-term effects need further observation.

Objective To study the sedative and analgesic effects of butorphanol combined with midazolam on critically ill patients treated by mechanical ventilation. Methods Fifty-eight patients who received mechanical ventilation, sedation and analgesia in intensive care unit (ICU) of Affiliated Huaian No.1 Hospital of Nanjing Medical University from January 2012 to December 2013 were enrolled. The patients were divided into a single midazolam group (30 cases) and a combination of butorphanol and midazolam group (combination with butorphanol group, 28 cases) according to the difference in types of sedative. The sedation for patients in the single midazolam group was induced firstly by intravenous injection of 0.05-0.10 mg/kg midazolam and followed by continuous infusion of the same drug 0.05 - 0.15 mg·kg-1·h-1 with a micro injection pump. The patients in the combination with butorphanol group were given a loading dose of butorphanol 10μg/kg and followed by continuous infusion of 10-20μg·kg-1·h-1 butorphanol combined with 0.05 - 0.15 mg·kg-1·h-1 midazolam by a micro pump. The Ramsay anesthesia score and visual analogue scale (VAS) were used to evaluate the sedative and analgesic effects. According to the Ramsay score, the sedation depths of patients in the two groups were maintained at 2-4 grades, and reassessed every 1-2 hours. The mean arterial pressure (MAP), heart rate (HR) and pulse blood oxygen saturation (SpO2) were observed before and after the drug administration in two groups. Results There were no statistically significant differences in MAP, HR and SpO2 between single midazolam group and combination with butorphanol group before treatment [MAP (mmHg, 1 mmHg=0.133 kPa): 121.3±6.2 vs. 118.6±8.7, HR (bpm):129.5±14.1 vs. 125.5±16.3, SpO2:0.744±0.112 vs. 0.756±0.131, all P>0.05]. Compared with those before treatment, after treatment, the above indexes in two groups were significantly improved, the differences being statistically significant [single midazolam group:MAP (mmHg) 88.7±6.5 vs. 121.3±6.2, HR (bpm) 85.3±13.4 vs. 129.5±14.1, SpO2 0.937±0.056 vs. 0.744±0.112; combination with butorphanol group: MAP (mmHg) 82.6±7.3 vs. 118.6±8.7, HR (bpm) 89.6±14.7 vs. 125.5±16.3, SpO2 0.943±0.078 vs. 0.756±0.131, all P < 0.05], and the degree of improvement of the combination with butorphanol group was better than that of the single midazolam group. The initial acting time of drugs and the time awakening from anesthesia in the combination with butorphanol group were shorter significantly than those in the single midazolam group (minutes: 33.6±6.2 vs. 73.3±12.2, 71.8±19.3 vs. 103.5±30.1, both P < 0.05), and the incidence of adverse reaction was lower obviously than that in the single midazolam group (0 vs.13.3%, P < 0.05). Furthermore, the score of VAS in the combination with butorphanol group was lower significantly than that in single midazolam group (8.4±1.2 vs. 2.4±0.8, P < 0.05). Conclusions Butorphanol combined with midazolam for treatment of critically ill patients with mechanical ventilation is a very effective sedative method, which may improve the degree of patients' tolerance towards the measure and reduce the incidence of adverse reactions.

Objective To discuss the change of cellular immune and humoral immune function in children patients with Henoch-Schonlein purpura(HSP)and to investigate its clinical significance.Methods The expression levels of T lymphocyte CD3 + ,CD3 +CD4 + ,CD3 + CD8 + ,CD3 + CD4 + CD8 + ,B lymphocyte CD3 - CD19 + and NK lymphocyte CD3 - CD16 + CD56 + in periphetal blood of 156 patients with HSP was detected by flow cytometry.The level of immunioglobins(IgG,IgA,IgM)and complement(C3,C4)of serum were evaluated by nephelometry immunoassay.The level of immunioglobin IgE was measured by immunochemiluminometric assays and compared with 25 healthy controls.Results Compared with control group,the ratio of CD4 +/CD8 + and the contents of CD3 + ,CD4 + cells in HSP patients were decreased significantly(P <0.01),while the content of CD19 + was significantly increased (P <0.01).The content of CD16 + CD56 + was decreased(P <0.05 ),while the content of CD3 + CD4 + CD8 + was increased(P <0.05),the content of CD8 + had no obvious change(P >0.01).The level of IgA and IgE were increased significantly(P <0.01).The level of IgG and C3 were increased (P <0.05),The level of IgM and C4 had no obvious change(P >0.05).Conclusion The cellular immune and humoral immune function in children with HSP are in disorder.To detect lymphocyte subsets,immunioglobin and com-plement will be of important significance to understand the immune function from the perspective of the cellular immune and humor-al immune to explore the pathogenic mechanisms and to assist diagnosis and patient′s prognosis.

OBJECTIVESTo increase the diagnosis and treatment of ectopic ACTH syndrome.

METHODSThe data of 12 ectopic ACTH syndrome patients treated from 1985 to 1999 were retrospectively analyzed.

RESULTSTwelve patients were diagnosed as having ACTH syndrome by endocrinary test and primary tumors were ascertained by imaging examination. Follow-up from 7 months to 8 years showed 3 out of 5 patients with radical resection of primary tumor died. One patient with bilateral adrenorectomy was still alive. All patients received only chemotherapy except one died.

CONCLUSIONSPatients with Cushing's syndrome should be evaluated by endocrine test and followed up by imaging screen examination. The key points to increase treatment effect include early detection, localization and resection of primary tumors.