Abstrac:Objective To analyze the efficacy and safety of medpor-coated tear drain in lacrimal bypass surgery without skin incision. Methods The data of 7 patients(7 eyes) who underwent no skin incision of lacrimal bypass surgery with medpor-coated tear drain were ret-rospective reviewed. The operation result and complications were observed. Results All patients were followed up for 5~17 months. Com-plete or significant improvement of epiphora was achieved in 5 cases at the last follow-up. Complications included conjunctival granulation hy-perplasia (3 eyes),nasal mucosal granulation hyperplasia (2 eyes),and discomfort (4 eyes). Conclusion The lacrimal bypass surgery with medpor-coated tear drain could be expected to improve epiphora of refractory lacrimal obstruction. The main complications are granulation hyperplasia and discomfort.

Objective To probe into the treatment method of filter channel obstruction after trabeculectomy. Methods Filter channel obstruction occurred in 25 eyes within one month after trabeculectomy,and they were retrospectively analyzed. According to different parts of obstruction,they were divided into three types namely inner obstruction, middle obstruction and outer obstruction. Patients with inner ob-struction were given miosis, separation of the anterior synechia, and expansion of peripheral iris incision when necessary. Patienrts with mid-dle obstruction were given reconstruction of the trabecular incision. Patienrts with outer obstruction were given conjunctiva or sclera flap dis-section within 1 month afer trabeculectomy. Results Postoperative IOP ( intraocular pressure) decreased significantly compared with preop-erative IOP. The IOP stabilized at 13~21 mmHg in the fallowing 6~12 months after operation. Conclusion Taking appropriate measures could restore the filtration function within one month after trabeculectomy when the incision adhesion was not very close.

Objective To analysis and compare the proteomic differences between neural stem cells and motor neurons in embryonic spinal cord in rat and discover the key different proteins. Methods Separating the protein of cells by the 2-D fluorescence difference gel electrophoresis, and to analyse the differences of protein expression with DeCyder software, and to identify with high performance liquid chromatography-electrospray tandem mass spectrometry. Results About 1 300 protein spots from the cells were gained after gel analysis. Eighty-seven protein spots were selected for mass spectrometry analysis. Fourty-four differently expressed proteins (24 in neural stem cells and 20 in motor neurons) were identified by mass spectrometry analysis.Conclusion Differently expressed proteins between neural stem cells and motor neurons were identified and it is helpful to find the new targets in neural stem cells differentiation into motor neurons.

Background Retinal neovascularization (RNV) is one of the major causes of blindness worldwide,but the pathogenic mechanism of this disease remains unclear, and therapeutic modalities need to be improved.Therefore,it is necessary to identify ocular protein markers with significant expression changes during RNV, thereby providing novel therapeutic targets for neovascular retinopathies.Objective This study was to investigate retinal vessel morphological characteristics and protein expression profiling in a mouse model of oxygen-induced retinopathy (OIR).Methods Forty four C57BL/6J mouse pups were randomly divided into normal control group and OIR group at postnatal day 7 (P7).The mice in the normal control group were raised under the normal air for 10 days.The mice of the OIR group were exposed to (75±2)％ oxygen for 5 days.The mother mice were alternated between the two groups every day.The mice of the OIR group returned to normal air at P12.Fluorescein isothiocyanate-dextran (FITC-dextran) was retrobulbarly injected at P17 mice from both groups, and the retinal flatmounts were prepared after fixation.The FITC-dextran-labeled retinal vessels were observed and quantified;the paraffin sections of eyeballs were processed for hematoxylin and eosin staining,and the number of pre-retinal vascular cell nuclei was quantified.The total proteins were extracted from the eyes, and the expression profiling was analyzed by a customized protein array and verified by Western blot and ELISA.Results The retinal flatmounts labeled with FITC-dextran showed that the peripheral retinal microvessels in the OIR group were tortuous, disorganized with neovascular buds,and the vascular obliteration was prominent in the center of retina.Contrastly,the vessels were smooth,organized, and evenly distributed in the normal control group.The percentage of vascular obliteration area in the OIR group was (25.53±2.16)％ ,which was significantly higher than (0.66±0.36)％ in the normal control group (t=-27.61 ,P＜ 0.01).The number of pre-retinal vascular cell nuclei,as revealed by hematoxylin and eosin staining, was (28.41 ± 3.97)/slide in the OIR group, which was substantially higher than (0.16±0.31)/slide in the normal control group (t =-54.42,P＜0.001).Protein array showed that 10 out of the 62 examined pro-inflammatory, pro-angiogenic cytokines exhibited more than 1.5-fold expression changes,including 3 up-regulated cytokines and 7 down-regulated cytokines;4 cytokines showed more than 2-fold expression changes,in which 3 cytokines were down-regulated and 1 cytokine was up-regulated.The differential expressions were verified by Western blot and ELISA.The expression trends of platelet factor 4 (PF-4), vascular endothelial growth factor A (VEGF-A), selectin P (SELP), vascular cell adhesion molecule 1 (VCAM-1) ,soluble tumor necrosis factor receptor Ⅱ (sTNF-RⅡ) and chemokine C-X-C motif ligand 16 (CXCL16) were consistent with those revealed by protein array.PF-4,VEGF-A and SELP were up-regulated,and the other 3 were significantly down-regulated (all at P＜0.05).Conclusions Differential expression patterns of the cytokines,including PF-4,VEGF-A, SELP, VCAM-1, sTNF-RⅡ and CXCL16, are identified between normal and OIR mouse eyes.These differential expression patterns suggest that under the condition of OIR,the platelet system is activated,and proinflammatory factors are down-regulated.PF-4 might become a new target for VEGF-independent therapeutic strategy against RNV.

Blepharospasm is a focal dystonia of the orbicularis oculi muscles, producing excessive eye closure. The etiology and pathogenesis is still unclear now. lt is usually appearing in adult period and predominant in females. The symptoms are typically triggered by stress, fatigue, intense light or individual factors. At advanced stages patients develop functional blindness. At present the main treatments include: botulinum toxin ( BTX ) , surgical procedures, systemic and ocular drugs and traditional Chinese medicine treatment. BTX administration has been an effective treatment. Surgical procedures have good effect but should be limited to the rare patients that do not respond to botulinum toxin treatment. A great variety of drugs have poor results. Chinese medicine has a certain therapeutic effect. Transcranial magnetic stimulation can improve symptoms. The epidemiology, anatomy, physiology, clinical manifestations, differential diagnosis, pathogenesis and treatment system were reviewed in this paper.

Objective To compare the advantages and disadvantages of three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases.Methods All of 90 patients with the single segmental lumbar vertebral diseases were treated from June 2012 to June 2013,including 34 males and 56 females,at the age of 27-76 years old,averagely (53.37± 15.41) years.Twenty-seven patients were treated with unilateral pedicle screws via unilateral muscle-splitting approach (unilateral fixation group).Thirty-three patients were treated with unilateral pedicle screws and contralateral translaminar facet screw via unilateral muscle-splitting approach (combined fixation group).Thirty patients were treated with unilateral pedicle screws via bilateral muscle-splitting approach (bilateral fixation group).Observe and compare the imaging and clinical results of these three groups.Results There were no significant difference in incision length and postoperative wound drainage between these three groups.The operation time was shortest in unilateral fixation group,while longest in bilateral fixation group.In the intraoperative blood loss,the unilateral fixation group was the same as the combined fixation group,while less than the bilateral fixation group.No infection was found after operations.Seven patients experienced epidermal necrosis of the incision,including 1 patient of unilateral fixation group,4 patients of combined fixation group and 2 patients of bilateral fixation group.Three patients suffered from nerve injury,including 2 patients of combined fixation group and 1 patients of bilateral fixation group.The follow-up time was from 12 to 36 months,averagely 25.5 months.The intervertebral height of lesion segments was apparently recovered after surgery,and maintained during the follow-up in these three groups.No significant changes of area and grade of multifidus muscle were detected at 1 year after surgery compared with preoperative.Seven patients experienced endplate cutting and cage partially embedded into vertebral body,including 3 patients of unilateral fixation group,3 patients of combined fixation group and 1 patient of bilateral fixation group.There was no loosening,displacement,breakage or cage shifting.Except 5 patients (2 patients of unilateral fixation group,2 patients of combined fixation group and 1 patient of bilateral fixation group),the remaining cases had well interbody fusion.At the final follow-up time,the JOA score significantly increased compared with preoperative.Besides,unilateral fixation group and combined fixation group were superior to bilateral fixation group.Conclusion Three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases had well clinical results.The unilateral fixation and combined fixation via muscle-splitting approach had more advantages.The combined fixation via muscle-splitting approach is an innovation in approach,exposure and fixation aspects.

Objective To perform a preclinical test of a delineation software based on atlas-based auto-segmentation (ABAS),to evaluate its accuracy in the delineation of organs at risk (OARs) in radiotherapy planning for nasopharyngeal carcinoma (NPC),and to provide a basis for its clinical application.Methods Using OARs manually contoured by physicians on planning-CT images of 22 patients with NPC as the standard,the automatic delineation using two different algorithms (general and head/neck) of the ABAS software were applied to the following tests:(1) to evaluate the restoration of the atlas by the software,automatic delineation was performed on copied images from each patient using the contours of OARs manually delineated on the original images as atlases;(2) to evaluate the accuracy of automatic delineation on images from various patients using a single atlas,the contours manually delineated on images from one patients were used as atlases for automatic delineation of OARs on images from other patients.Dice similarity coefficient (DSC),volume difference (Vdiff),correlation between the DSC and the volume of OARs,and efficiency difference between manual delineation and automatic delineation plus manual modification were used as indices for evaluation.Wilcoxon signed rank test and Spearman correlation analysis were used.Results The head/neck algorithm had superior restoration of the atlas over the general algorithm.The DSC was positively correlated with the volume of OARs and was higher than 0.8 for OARs larger than 1 cc in volume in the restoration test.For automatic delineation with the head/neck algorithm using a single atlas,the mean DSC and Vdiff were 0.81-0.90 and 2.73％-16.02％,respectively,for the brain stem,temporal lobes,parotids,and mandible,while the mean DSC was 0.45-0.49 for the temporomandibular joint and optic chiasm.Compared with manual delineation,automatic delineation plus manual modification saved 68％ of the time.Conclusions A preclinical test is able to determine the accuracy and conditions of the ABAS software in specific clinical application.The tested software can help to improve the efficiency of OAR delineation in radiotherapy planning for NPC.However,it is not suitable for delineation of OAR with a relatively small volume.

Objective To evaluate the relationship between sternum protection and bone marrow suppression in postoperative radiotherapy for esophageal carcinoma. Methods Total of 98 postoperative patients with thoracic esophageal carcinoma were randomly divided into experimental group (52 cases) and control group (46 cases). All patients were given intensity-modulated radiotherapy (IMRT), with the dose of 50-50.4 Gy. The patients in experimental group were irradiated by 6 fields (4-fields in front, 2-fields behind) which were crossed to avoid direct exposure to the sternum. The patients in control group were irradiated by 5 fields (3-fields in front, 2-fields behind) with front-middle of the field passing through the sternum. Concurrently all patients received 2 cycles of cisplatin chemotherapy. Results Dmean, V20 and V30 of the sternum in the experimental group were (20.21 ±3.60) Gy, (40.78 ±7.19) % and (33.78 ±9.44) %, which were lower than those in the control group [(30.91±5.21) Gy, (81.01±4.81) %, (51.60±6.84) %], respectively (P<0.05). However, the volume and dose distribution of lung, spinal cord and heart were similar between the two groups (P> 0.05). Both the incidence rates of bone marrow suppression at 14th day and 35th day after radiotherapy were significantly higher in the control group (52.2%, 73.9%) than those in the experimental group (28.8 %, 50.0 %) (P< 0.05), and the incidence rate of bone marrow suppression at 7th day after radiotherapy was similar between the two groups. Conclusion Protecting and sketching for sternum in postoperative radiotherapy for esophageal carcinoma can reduce the incidence of bone marrow suppression effectively, which would not increase the radiation dose in the lung, heart and spinal cord.

Objective:To assess the potential or limitation of MRI for demontrating the pathological cervicallymphnodes. Method :A prospective diagnostic study on cervical lymphnode metastasis from laryngeal carcinomawas performed for 19 cases undergone neck dissection (5 cases undergone bilateral neck dissection, 24 specimensof neck dissection were collected in total). With pathological findings as the criterion, sensitivity and specificityand accuracy were calculated for palpation and MRI examination of all patients. Result:MRI had obviously highersensitivity specificity and accuracy than palpation. Besides the changes in size and shape of the metastaticlymphnodes, the intensity of MRI inside the metastic lymphnodes was showed as mixed hypo-isointensity inT1WI and hyper intensity in T2WI. Conclusion:MRI examination was accurate in detecting cervical lymphnodemetastasis and could image occult lymphnodes which are inaccessible on palpation. Thus, MRI will probably playan important role in the evaluation of malignant lymphnode metastasis.

Surface transcutaneous electric nerve stimulation(TENS) was applied to treat the spasiticity resulting from spinal cord injury(SCI) in the acupoints of the subjects with SCI in order to oberve thetranscient and long-term effect of the treatment Fand its mechanism will be discussed in this paper. The results show that: 1 )more significant effect in relieving the spasiticiy was got by stimulating in high frequencyfor 30minutes,while less effect in low frequency(2Hz) ; 2)the effect in high frequency was partially ostracized by naloxone; 3)the effect in high frequency lasted for a long time i 4)compared with lumbar and sacralstimulation,the acupoint stimulation lasted for the longest time. This study also gets a hypothesis that highfrequency TENS in acupoints improves dynorphin in CSF to release and significantly relieve the spasiticityby kappa opioid receptor which decreases the excitment of anterior motor neuron.