Background Vitretomy and lenstomy with silicone oil tamponade is an effective method for complicated vitreous retinopathy.The severe anisometropia after silicone retention is usually treated by two-point transscleral suture fixation for posterior chamber intraocular lens(IOL)implantation.In order to reduce the number and difficulty and complication of the operation,the surgical method should be improved.Objective The goal of this study was to observe the resuh of silicone oil removal combined with four-point trans-scleral suture fixation of posterior chamber IOL after vitrectomy.Methods A retrospective case-observational study design was adopted.Twenty eyes with silicone oil tamponade from 20 patients without lens and posterior capsule after vitrectomy were included in this study.Silicone oil removal with four-point trans-scleral suture fixation of posterior chamber IOL was performed.The anterior ocular inflammatory response,intraocular pressure,uncorrected and corrected acuities before and after operation,corneal endothelial cell counting and postoperative complications were observed and analyzed.Written informed consent was obtained from all patients prior to the operation.Results All of the operative eyes in this study showed improvement of visual acuity after operation.Of the 20 eyes,a visual acuity of ≥0.8 was seen in 2 eyes,0.6-0.7 in 6 eyes,0.3-0.5 in 8 eyes and 0.05-0.2 in 4 eyes 3 months after the removal of silicone oil.The uncorrected acuity postoperation was significantly improved in comparison with preoperation(H=10.147,P＜0.01),but no significant difference was found in the corrected acuity between preoperation and postoperation(X =2.089,P＜ 0.01).The number of the corneal endothelial cells was(2064±329)cells/mm2 before operation,and that after operation was(1987±269)cells/mm2,showing an insignificant change between them(t =1.660,P ＞ 0.05).No abnormality of IOL position was found in all 20 operated eyes.There was not serious postoperative complication in all 20 patients.Conclusions The combination of silicon oil extraction with four-point transscleral suture fixation IOL is effective in eyes without posterior capsule or lens after vitrectomy.It can reduce the operation time and improve the postoperative acuity and the quality of life of patients.

AIM To evaluate the anti-angiogenesis action of Bevacizumab on corneal neovascularization(CNV) in rats induced by alkali burns.·METHODS: 20 Health Wistar rats, aging from 6 to 8 weeks and weighting from 170g to 190g from 170g to 190g were prepared for CNV animal models. Both corneas of each animal in experimental were cauterized with alkali, then all rats were randomly divided into four groups (each group have 5 rats and 10 corneas), the both corneas of each rats were received subconjunctival Bevacizumab in different dosage (group 2, 0.5rag; group 3, 1.0mg; group 4, 2.0mg)and the group 1 received carrier solution. The occurrence and development ofCNVwereobservedbyslit-lamp microscope, and length and area of CNV were calculated. All rats were followeded up 16 days after alkali burns. The 40 corneas were taken for histopathological examination. Vascular endothelial growth factor (VEGF) were detected in all rat corneas by immunohistochemistry method. ·RESULTS: In the bevacizumabotreated eyes, the vascular area was lower than in the control eyes. The treated group was statistical differences compared with the control group; when vascular area were compared between the treated groups, no statistical differences were observed. The histopathological findings showed that the inflammation cells and the neovascularity in each treated group were significantly fewer than that in the control group. The expression of VEGF markedly increased in CNV control group compared with bevacizumab-injected group. ·CONCLUSION: Subconjunctival application of a certain concentrations Bevacizumab could inhibit angiogenesis in rats corneas induced by alkali burns.

Background At present,researches about retinitis and acquired immunodeficiency syndrome (AIDS) mainly focus on observation and analysis of the cytomegalovirus (CMV)-induced ocular complication.To screen the effective drugs is very important for the treatment of AIDS-related CMV-induced retinitis.Objective This study was to describe the clinical features,diagnosis and treatment outcome of CMV-induced retinitis with BAY 38-4766 and evaluate the relationship between CMV retinitis and AIDS.Methods This was a case observational study.A total of 154 eyes of 84 patients with CMV retinitis and AIDS were enrolled in this study.Before the definitive diagnosis of CMV retinitis,the AIDS course of these patients were 4-26 months.In the initial examination,the visual acuity ranged from finger counting to 0.4,and the number of CD4+ T-lymphocyte was 0-30 cells/μl.The survival time in the patients ranged from 3 weeks to 18 months.BAY 38-4766 was used in 117 eyes of 62 patients,and 102 eyes of 53 patients showed the srinked of retinal lesion and improvement of vision (0.1-0.7).BAY 38-4766 was used to treat the CMV retinitis in 117 eyes of 62 patients with the initial intravenous dose of 5 mg/kg,twice per day for consecutive 2 weeks and followed by oral dose 1 gram per day.The follow-up duration was 2 weeks to 18 months.The fundus feature,visual acuity and CD4+ T-lymphocyte counts were analyzed.This study proposal was approved by Ethic Committee of the 474th Hospital of PLA,and written informed consent was obtained from each patient prior to entering this study.Results The numbers of CD4+T-lymphocytes increased to 12-402 eells/μl after administration of BAY 38-4766.The CMV retinitis aggravated and the vision decreased in the untreated 22 patients with the CD4+T-lymphocytes 0-30 cells/μl.Conclusions CMV retinitis is the most common intraocular complication in patients with AIDS.Diagnosis of CMV retinitis is based on the characteristics of necrotizing retinitis,which is typically associated with retinal hemorrhage and vasculitis.BAY 38-4766 is an effective drug for the treatment of CMV retinitis.

Objective To evaluate the safety and effectiveness of capsule endoscopy(CE) in a large cohort of the elderly patients with obscure gastrointestinal bleeding(OGIB). Methods The demographic, clinical and diagnostic data of all geriatric patients with obscure gastrointestinal bleeding who underwent CE between May 2002 and February 2007 were retrospectively analyzed. For comparison, non-geriatric patients with obscure gastrointestinal bleeding who underwent CE during the same period were selected as the control group. Results Ninety-seven geriatric patients [40men/57 women, mean age (70.84-6.8) yrs]and ninety-nine non-geriatric patients [61 men/38women, mean age (44. 4±10. 3) yrs)were retrospectively reviewed. Eighty-nine patients presented with overt OGIB while eight patients had occult OGIB in the geriatric group. The section in the nongeriatric group was ninety-one and eight respectively. No significance was seen in the gastric transit time, completion rate and delay rate between two groups. The small bowel transit time was significantly longer in the geriatric group than that in the non-geriatric group (P<0. 05). Sixty-two patients in the geriatric group obtained positive diagnosis and angiodysplasia was the most frequent lesion;while sixty-seven patients in the non-geriatric group obtained positive diagnosis and Crohn's disease was the most frequent lesion. No significance was seen in the positive diagnostic rate between two groups (P>0. 05). However, the constituent ratio of the positive diagnosis was significantly different between two groups (P<0. 01). Conclusions CE is a safe and effective procedure for geriatric patients with obscure gastrointestinal bleeding. Angioectasia accounts for the majority of positive findings in geriatric group.

objective To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.Methods A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done.This included 300 consecutive patients.The median age of the patients was 51y (range,3～91Y).The young children group was defined as less than 10 years and the elderly group as more than 80 years.Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient.The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed.The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group,elderly group and patients with pacemakers,gastrectomy and Billroth Ⅱ gastrojejunostomy,intestinal diverticula,Crohn's disease and polyp of small intestine.Results A total of 300 patients were involved.The incidence of technical problems was 1.3%.including one case of failing in activating the capsule,one case of failing in loading the data and two cases of short life of battery.Failure of diagnosis was encountered in two cases.The incidence of clinical problems was 33.0%(99 cases)and they caused 35.4%(35 cases)failure of diagnosis in the 99 cases.Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all.In the elderly group.the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%.In two patients with pacemaker no interference between pacemaker and capsule was detected.In two patients with Billroth Ⅱ gastrojejunostomy uo capsule retention occurred.In 16 patients with diverticulum,capsule retention occurred in 1 case(6.0%).In 42 patients with Crohn's disease,capsule retention occurred in 5 cases.No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.Conclusions With capsule endoscopy technical mistakes causing failure were very rare.The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time.Capsule endoscopy provides a well-tolerated,safe and effective tool to investigate the gastrointestinal diseases.especially some small bowel diseases.

Total knee arthroplasty (TKA) identified as an effective treatment for ultimate knee joint disease can effectively relieve pain, correct deformity, improve knee function and enhance the quality of life of patients. Patient satisfaction has been increasingly considered as an important factor in evaluating the success of primary TKA. Anterior knee pain that usually appears in the region of the anterior knee is a recognized complaint for primary TKA and has a strong impact on the improvement of knee function and patient satisfaction of primary TKA. Accordingly, the relief of anterior knee pain has become one of the primary goals of primary TKA. At present, soft tissue lesions around the patellar caused by patellar maltracking and the elevation of internal pressure in subchondral bone because of the high contact stress of patellofemoral joint are both considered as the mechanism of anterior knee pain. For the past few years,on increasing number of studies have focused on the prevention of anterior knee pain following primary TKA. However, none of the past treatment such as patellar resurfacing, patellar denervation without patellar resurfacing or a mobile-bearing prosthesis has a good and affirmative effect on it. The prevention and treatment of anterior knee pain following primary TKA still is a difficult solved problem. To address this problem, we need further researches about the cause of anterior knee pain, knee joint prosthesis and biomechanics of patellofemoral joint, as well as lots of randomized controlled trials.
Arthralgia ; etiology ; prevention & control ; Arthroplasty, Replacement, Knee ; adverse effects ; Humans ; Knee Joint ; surgery ; Randomized Controlled Trials as Topic

Background Diabetic retinopathy (DR) is one of the most important microvascular complications of diabetes,which has become one of the leading causes of blindness.Neovascularization is the main pathological manifestations of DR,but its mechanism is unknown.There is a clear need to investigate its pathogenesis which can offer potential therapeutic targets.Objective The aim of this study was to investigate the expression and distribution of visfatin and vascular endothelial growth factor (VEGF) in diabetic model rats.Methods This study was approved by Animal Ethic Committee of Inner Mongolia Medical University.Sixty SPF 8-week-old male SpragueDawley rats were randomized into the diabetic group and control group.The rats were housed under a condition that alternated between 12 hours of light and darkness,with free access to rat food and water.Diabetes was induced by intraperitoneal injection of 60 mg/kg (0.60 ml/100 g) of streptozotocin (STZ) and control rats received equivalent volume of buffer.The models were regarded as successful when blood glucose was ≥ 16.7 mmol/L.Rats were sacrificed 12 weeks after the injection of STZ and retinal specimens were prepared to detect the expression of visfatin and VEGF.Total retinal protein was isolated from the retinas of experimental and control eyes,and the expression of visfatin and VEGF was assessed by Western blot.Frozen cross sections of retinas of 5 μm thickness were used to perform double immunofluorescence staining with anti-visfatin and anti-VEGF antibodies.Results Mean body weight of the diabetic rats was (189.02±11.34) g and that of the control rats was (489.57 ± 14.48) g at 12 weeks post-injection,showing a significant difference between them (t =5.236,P =0.003).Mean blood glucose level was (29.25±3.86) mmol/L in the diabetic group and (5.32±1.01) mmol/L in the control group,demonstrating a significant difference (t =11.778,P =0.000).Double immunofluorescence staining showed reduced expression of visfatin and VEGF in the retinal nerve fibrous layer and glial cells in the control rats.A stronger staining for visfatin and VEGF was found in the various layers of the retina in the diabetic rats,with an expression level of visfatin (A value) of 346.26±41.23,which was considerably higher than that of the control group (102.07±65.01) (t =8.291,P =0.000) in 12 weeks after injection.Furthermore,the expression of VEGF in the retina was elevated in the diabetic group compared with the control group (A value) (415.88±92.15 vs.113.06±32.06) (t=10.067,P=0.000).Conclusions Visfatin might contribute to the pathologic progression of diabetic retinal,neovascularization and it might play a synergistic role with VEGF in the pathophysiology of DR.

Adolescent ; Humans ; Male ; Neurofibromatosis 1 ; Neurofibromatosis 2

Objective To investigate the effects of pulsed magnetic fields of different intensity on carotid restenosis (CRS), post carotid endarterectomy (CEA) and the expression of matrix metalloproteinase-2 (MMP-2)in vascular smooth muscle cells (VSMC). Methods An animal model of carotid altherosclerosis was established in 50 New Zealand rabbits by using air-drying lesions combined with high fat feed. After two months, the rabbits were treated with bilateral CEA, and then divided randomly into 3 groups. Two of the groups were treated with ei-ther 0.6 or 1.0 T pulsed magnetic fields, while the third group served as an untreated blank control. Changes in the pathology of the tunica intima were observed 1, 2 and 3 months after the CEA using morphologic analysis, and the expression of MMP-2 in the VSMC was determined using immunohistochemistry. Results The histological a-nalysis showed that the total luminal area, plaque area, the maximum plaque thickness and the proportion of siena-sis in the treated groups were all significandy lower, on average, than in the control group. At all three time points the average improvements in the 1.0 T group were significantly greater than in the 0.6 T group. The average ex-pression of MMP-2 in the treated groups was significantly lower than in the control group, especially in the 1.0 T group. Conclusions Pulsed magnetic field therapy positively influences CRS and the expression of MMP-2 in VSMC. Reduced MMP-2 expression might be one of the mechanisms through which pulsed magnetic fields prevent or lessen carotid restenosis post CEA.