Primary glaucoma is a group of blinding eye diseases,including of primary open angle glaucoma (POAG),primary angle-closure glaucoma (PACG) and primary congenital glaucoma (PCG).It is thought that the pathogenesis of primary glaucoma is a comprehensive action of genetic factor,environment factor and life style,and the genetic factor plays an important role.CYP1B1 gene was firstly identified as a causal gene for PCG in 1997.After that,thousands of reports on the pathogenesis of POAG focused on CYP1B1 gene mutation.With the developing of research,researches found that CYP1B1 gene to be one of the candidate genes of POAG.The structure and function of CYP1B1 gene,the relationship between CYP1B1 and POAG were reviewed.

Objective To investigate the early diagnosis of sudden cardiac death so as to increase the resuscitating success rate.Methods 24 cases with sudden cardiac death were analyzed.Results In 24 cases,there were 10 cases resuscitated successfully,8 cases with heartbeats recovered died in 1～3 days,5 of which had average blood glucose of 21.6 mmol/L and blood sodium of 156 mmol/L,and 6 cases resuscitated unsuccessfully.Conclusion 70.83% was caused by AMI in 24 cases.The early diagnosis of AMI is mainly based on clinical manifestation.Althogh early ECG did not show it,AMI should not be denied and misdiagnosed.Resuscitation should be performed on the spot as soon as cardiac arrest occurs.Naloxone and NaHCO3 should be used rationally.Meanwhile,be sure to prevent and treat reperfusion-injury.The prognosis would be extremely poor if the patient showed hyperglycemia and hypernatremia during resuscitation.

Objective To explore whether acute graft versus host disease (aGVHD) could be alleviated by syngeneic bone marrow mixed with granulocyte colony stimulating factor (G CSF) mobilized H 2 haploidentical marrow grafting. Methods Female BALB/c and neonatal BALB/c mice were recipients and male (BALB/c?C 57 BL/6) F 1 (BCF 1) mice were donor mice respectively. Donor mice were injected subcutaneously with G CSF daily at 0.01 ?g/g body weight or saline for 6 days, and splenocytes were harvested on day 6. Spleen index(SI) represented GVHD in neonatal mice after the intraperitoneal injection of mixed spleen cells.Lethally irradiated ( 60 Co, 8.5 Gy) adult mice were transplanted with a mixture of syngenetic plus G CSF mobilized (control diluents) H 2 haploidentical marrow cells.Survival time and survival rate of the recipients were observed after mixed marrow transplantation (MBMT). GVHD was assessed by observing signs of weight loss, ruffled fur, diarrhea and histological change of skin, liver and small intestines. Enzyme linked immunosorbemt assay (ELISA) method was used to detect cytokines (IL 2, IL 4, IFN ?). Fluorescence activated cell sorting (FACS) analysis was used to detect T cell phenotype. Results (1) The neonatal mice subject to injection of 2∶1 and 1∶1 mixed spleen cells and H 2 haploidentical spleen cells all suffered from aGVHD. The severity of aGVHD in recipient mice receiving G CSF mobilized splenocytes was dramatically reduced. (2) The aGVHD signs and histological change were observed in most mice of 2∶1 and 1∶1 MBMT groups. However, the survival time of G CSF mobilized MBMT groups was longer than in control groups ( P

Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected.

OBJECTIVE To investigate and analyze the reasons of nosocomial infection(NI) in patients in intensive care unit( ICU),to find effective countermeasures for preventing NI and reducing the incidence rate of NI in ICU,and to enhance the management of ICU.METHODS All data of patients who suffered MRSA in ICU from Dec 2005 to Feb 2006,were analyzed by prospective monitoring and retrospective studies.RESULTS The nine patients were with lower respiratory tract.All were infected by the same MRSA.The same MRSA strain was found from hand,mouth and nose among the treating doctor and nurses based on the sample-analysis.CONCLUSIONS The incidence rate of NI in ICU is much higher than that in other departments.Risk factors depend on the severity of underlying diseases,invasive procedure,the quality of disinfection and sterilization,the incorrect use of the antibiotic,and patients′ immunity status especially among elderly.The key way to reduce incidence rate of NI is to take comprehensive measures and strengthen the antibiotic management.

BACKGROUND: Bone marrow necrosis has unspecific clinical features, which is often misdiagnosed or missed due to a lack of the knowledge of the disease. OBJECTIVE: To improve the awareness and vigilance to bone marrow necrosis, and to further explore the clinical manifestations, hematological characteristics, pathogenesis and treatment of bone marrow necrosis. METHODS: The bone marrow necrosis, hematologic neoplasms, solid tumor, bone marrow puncture, bone marrow pathology in Chinese and English served as the search terms to search articles related to bone marrow necrosis in PubMed and Wanfang databases, published from 1941 to 2016. Totally 43 articles were selected for review. RESULTS AND CONCLUSION: Bone marrow necrosis is a rare complication caused by various diseases, clinically characterized by bone pain, fever, anemia, and nucleated red cells and immature neutrophilic leukocytes in the blood smear. Bone marrow aspiration and/or bone marrow biopsy show(s) necrotic features. Its pathogenesis is complex, and it is still poorly understood and needs further research. There is no good treatment for bone marrow necrosis, and the prognosis is poor. Early correct diagnosis and etiological treatment are crucial for the prognosis of bone marrow necrosis.With the improvement of disease awareness, bone marrow cytology, genetics, MRI and hematopoietic stem cell transplantation, bone marrow necrosis is expected to get a better prognosis.

The clinical internship is an important transitional period for humanistic spirit cultivation of the medical students.But in this period there are some problems exposed.For example,there is the lack of transitional link in management; the clinical instruction doctors lack educational consciousness or guidance ability,the medical students pay little attention to enhancing the individual humanistic spirit level and there is a gap between theory and practice of humanistic spirit for them.Strengthening training for students,attaching importance to training,selection and incentive of clinical instruction doctors and revising handbook of clinical internship will help to solve the problems.

Objective To evaluate the efficacy and safety of preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction based on literature. Methods The randomized clinical trials (RCT) on the subject were retrieved from PubMed,OVID,EMBASE,Cochrane library,CNKI,Wanfang data and VIP Chinese Scientific and Technologic Periodical Database.Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P ＜ 0.1.Heterogeneity of the included articles was tested,which was used to select proper effect model.Publication bias was investigated through visual inspection of funnel plots.Results Five RCT including 283 cases were analyzed,in which 145 patients received preoperative colonic stenting and 138 received emergency surgery.Compared with those of emergency surgery groups,the total OR of permanent stoma,one-stage operation,and infection of preoperative colonic stenting group were 0.28 (95％ CI:0.12 - 0.62,P =0.002),2.13 (95 ％ CI:1.28 - 3.55,P =0.004) and 0.25 (95％ CI:0.08 - 0.80,P =0.02),respectively.There were no significant differences between 2 groups in anastomotic leakage,mortality,intra-abdominal infection,or overall morbidity.OR were 0.70 (95％ CI:0.29 - 1.71,P =0.44),1.17 (95％ CI:0.49 -2.79,P=0.72),0.27 (95％CI:0.03-2.65,P=0.26) and 0.32 (95％CI:0.07-1.42,P=0.13),respectively.Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias.Conclusion Preoperative colonic stenting significantly improves one-stage operation and decrease the rates of permanent stoma and wound infection.However,large-scale and high-quality RCTs are further needed.

Objective To explore the effect of electroacupuncture (EA) at tusanli (ST36) on regulation of stress response under different doses of etomidate anesthesia in rats.Methods Sixty male Sprague-Dawley rats, weighing 280-310 g, were randomly divided into control group (group C), model group (group M), etomidate 60 mg/kg group (group E1), etomidate 30 mg/kg group (group E2), etomidate 60 mg/kg combined with EA group (group EA1) and etomidate 30 mg/kg combined with EA group (group EA2), n=10 in each group.All groups received inferior caudal trunk transection at the level between sacral spinal nerve 3 and 4 (S3, S4) to prepare acute stress response model except group C.Group M received no others treatment.The rats in group E1, group EA1, group E2 and group EA2 were intraperitoneally injected with 60, 60, 30 and 30 mg/kg etomidate, respectively.Group EA1 and group EA2 received EA ST36.The points were stimulated at a frequency of 2/100 Hz with 1 mA output and a dilatational wave, which lasted for 30 min.ACTH and Cor levels were measured by ELISA.The c-fos protein expression in hypothalamic tissue was examined by Western blot.Results Compared with group C, ACTH and Cor levels, and hypothalamic expression of c-fos protein in group M were significantly increased (P<0.05).Compared with group M, serum ACTH and Cor levels, and hypothalamic expression of c-fos protein in groups E1, E2, EA1 and EA2 were significantly decreased (P<0.05).Compared with group E1, serum ACTH and Cor levels, and hypothalamic expression of c-fos protein were significantly higher in groups E2 and EA1 (P<0.05).Compared with group E2, serum ACTH level and hypothalamic expression of c-fos protein were significantly lower in group EA2 (P<0.05).Conclusion EA at ST36 regulating stress response under etomidate anesthesia in rats is effective and two-way, and the mechanism may be due to the release of neurotransmitters induced c-fos protein in hypothalamus.

Objective To investigate the injury of nonsteroidal anti-inflammatory drug (NSAID) in small intestinal mucosa and the protective role of muscovite.Methods From December 2012 to June 2013,28 healthy volunteers without intestinal mucosal injury showed by capsule endoscopy were selected as objects of this study.Based on computer-generated random number table,the subjects were divided into muscovite group and control group.Subjects of muscovite group orally took muscovite 3 g twice daily,diclofenac 75 mg twice daily and omeprazole 20 mg once a day.The medicine for control group were as same as muscovite group but no muscovite.Patient in both groups took medicines for two weeks.All subjects underwent capsule endoscopy examination after the medication.Before and after the medication,the clinical symptoms of subjects and the changes of small intestinal mucosa under endoscopy were compared.The t-test was performed for comparison between the groups in normally distributed measurement data.For non-normal distributed measurement data,Wilcoxon rank sum test was used for comparison between the groups.Chi-square test or Fisher's exact test was implemented for comparison between the groups of count data.Results There were no differences in the incidences of the injury of the intestinal mucosa,ulceration,petechiae and (or) erythema,mucosal exposure between muscovite group (5/14,4/14,3/14 and 1/14,respectively) and control group (10/14,8/14,7/14 and 3/14,respectively) (all P＞0.05).Both the incidences of intestinal mucosal erosions and lymphangiectasis of muscovite group (4/14 and 1/14) were lower than those of control group (10/14 and 8/14) and the differences were statistically significant (x2 =5.143,Fisher's exact test,both P＜0.05).All the number of injury of the intestinal mucosa,ulceration and erosions of muscovite group (0.00(2.00),0.00(1.00),0.00(1.25),respectively) were lower than those of control group (5.50(17.25),2.00(9.75),3.00(5.00),respectively) and the differences were statistically significant (Z=-2.156,-1.988 and -2.338,all P＜0.05).There was no statistically significant difference in the number of petechiae and (or) erythema between muscovite group and control group (P＞0.05).In muscovite group,the number of grade zero,one,two,three and four intestinal mucosa injury was nine,zero,one,three and one; in control group was four,zero,two,two and six.There was statistically significant difference between the two groups (Z=-2.108,P＜0.05).In muscovite group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 0.00(0.25),0.00(0.25),0.00(0.75),respectively,and there was no significant difference in the distribution of small intestinal mucosa injury in the group (all P＞ 0.05).In control group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 2.00(4.00),0.00(4.25),3.00(9.75),respectively,and there was statistically significant difference in the distribution of small intestinal mucosa injury in the group (x2 =7.189,P＜0.05).The number of small intestinal mucosa injury in the upper and lower sections of control group was more than that of muscovite group and the difference was statistically significant (Z=-2.087 and-2.502,both P＜ 0.05).Conclusion Short-term orally taking NSAID lead to small intestinal mucosal injury and muscovite could reduce NSAID-related small intestinal mucosal injury.