Twenty-one eyes of 13 patients with juvenile glaucoma confirmed by ocular tension, vision, eye ground and gonioscope underwent trabeculectomy combined with amniotic membrane transplantation. The posttransplant intraocular pressure significantly decreased compared to pretreatment (P

ObjectiveTo investigate the effects of alpha-lipoic acid on serum soluble intercellular adhesion molecule-1 (sICAM-1) and high sensitive-C reactive protein (hs-CRP) levels in patients with early diabetic nephropathy (DN).MethodsA total of 61 patients with early DN were randomized into treatment group (n =31 ) and control group ( n =30 ).The two groups were both treated with dietary control and oral hypoglycemic drugs or insulin.Meanwhile,the treatment group was additionally given alpha-lipoic acid 300 mg/d by intravenous infusion for 20 days.The levels of sICAM-1 and hs-CRP in each group were detected.Results The levels of sICAM-1 and hs-CRP were decreased significantly in alpha-lipoic acid treatment group after 20 days of therapy ( [ 198.03 ±23.67] μg/L vs [271.17 ±34.66] μg/L,[5.16 ±0.43] mg/Lvs [7.95 ±0.88]mg/L,P ＜0.01 ).Conclusion alpha-lipoic acid may decrease the expression of slCAM-1 and hs-CRP,and that may be one of the mechanisms to postpone the progress of early DN.

Objective Valve replacement is a conventional therapy for the mitral insufficiency caused by IE. Mitral valve repair as an optional procedure for the disease has become feasible in recent years. However, concerns from surgeons about the recurrence of endocarditis after mitral valve repair remained. in this study we evaluated the long-term clinical outcomes of patients treated with surgery for the mitral insufficiency caused by infective endocarditis (IE). Methods Between July 1990 and July 2007, 83 consecutive patients (male 62, female 21) with mitral valve IE were enrolled in this study. Forty-one (49.4% )patients received mitral valve repair ( MVP,group A) and 42(50. 6% ) patients received mitral valve replacement ( MVR, group B). Thirty-seven cases had concomitant aortic valve replacement; 1 patient had aortic valve repair; 4 cases had ventricular septal defect repair; 1 case had atrial septal defect repair, 12 cases had bicuspid valve repair; 2 cases had coronary artery bypass graft and 1 case had femoral artery thrombus. Intraoperative transesophageal echocardiography were performed in 18 cases for the evaluation of mitral valve regurgitation. Mean cardiopulmonary bypass time, aortic clamping time and postoperative ventilation time were recorded and analyzed. Mid- and long-term clinical and echocardiographic outcomes were assessed.Results Preoperative left ventricular end systolic diameter, left ventricular ejection fraction and the classification of New York Heart Association in group A were significantly lower than those in group B (P ＜ 0. 05), but no difference was observed between the 2 groups in the cardiopulmonary bypass time and the crossclamping time. However, the intubation time and ICU time were shorter in group A than those in group B ( P ＜ 0.05 ). More vegetations were seen in the MVR group than in the MVP group. Three (3.6% ) patients died after the operation in group B. All patients were assessed as in NYHA Ⅰ-Ⅱ at discharge.A follow-up was done between 1 to 165 months (mean 39 months) with a mean follow-up rate of 95%. In the MVR group, peri-valvular leakage happened in 1 case, cerebral hemorrhage happened in 2 cases and repetitive pleura! effusion in 1 case. One death happened in the MVR group and none in the MVP group. The 10-year survival rate (100% ) in group A was nonsignificantly higher in group A than that (75% ) in group B(P =0.081). Conclusion Mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide an optimistic long-term outcome to the patients. The indication for mitral valve repair is mild to moderate mitral valve lesion. Experienced cardiac surgeons, use of antibiotics before and after the operations based on drug-sensitivity test and blood test, as well as follow-up the patients yearly, are important factors for the favorite outcomes.

Objective: To determine the expression of Fas ligand (FasL) in the patients with esophageal carcinoma and its clinic significance. Methods: The expression of FasL was measured by immunohistochemical technique in 30 patients with esophageal cancer. The numbers of tumor infiltrationg (TIL) were accounted by immunohistochemically stained CD45. Results: 76.6% of specimen expressed FasL. The difference of FasL expression was significant between each TNM stage. There was a negative correlation between the number of TIL and the expression of FasL. Conclusion: The expression of FasL in esophageal carcinoma may correlate with its invasion and metastasis.

Objective To evaluate the operative results of 542 patients underwent mitral valve repair and the results of 20-years follow-up.Methods A total of 542 patients [306 males,236 females;mean age (38.75?19.38) years) underwent mitral valve re- pair between 1985 and 2006.Mean follow-up was (41.03?40.40) months (1～240 months),and follow-up was 90.8% complete. Results The post-operative mortality was 3.7 %,and 96.3 % of patients were in NYHA class Ⅰ and Ⅱ after surgery.During fol- low-up,there were 20 deaths and 23 reoperations.Survival at 7-year,10-year and 15-year was 91%,88% and 70%,respectively. Freedom from reoperation at 7-year and 10-year was 94% and 86%,respectively.Conclusion Valve repair in mitral leaflet disease is a standard technique,with a good operative results.

Objective To investigate the application of CUSUM (cumulative sum control chart) curve in cardiac clinical teaching of resident surgeon education.Methods We chose a surgeon of 10years work experience of attending the preparation operation of internal mammary artery as control reference (standard group,28 patients) and a resident engaged in professional clinical cardiac work no more than 5 years as group 1,a professional training physician engaged in cardiac surgery clinical work more than 5 years as group 2 and took 40 patients' data respectively from the two groups' preparation of internal mammary artery operation.And then we recorded the postoperative mammary artery flow,internal mammary artery preparation time and adverse events data and made statistics analysis with SPSS 19.0,and CUSUM curve with Matlab R2012b polynomial curve.Results When the density of operate interval and the operate numbers came to about 25 cases,the polynomial eurve's slope rate went up to 0,regardless the surgeons' experience,CUSUM value was accumulated from 66 to 76,and overcame the learning curve successfully.However,when the density of operate interval did no reach the standard,the surgeon's CUSUM ploynomial cmwe slope rate never reached to 0,and can't overcome the learning curve.Conclusion CUSUM curve gives a clear quantitative indicator to the cultivation of clinical physician,and makes teaching teachers can understand the young physicians' learning process,so as to change the teaching plan,help young physicians cross the learning curve as soon as possible.

Objective To examine the effect of hydroxyethyl starch (HES 6%, 200/0.5) on reticuloendothelial system (RES) function in hemorrhagic shock. Methods Thirty 8 to 12-week-old Wistar rats weighing 250-350g were randomly divided into two groups: HES group ( n = 15) and control group ( n =15) . The animals were anesthetized with intraperitoneal 0.5% pentobarbital sodium 30mg ?kg-1 Bilateral common carotid arteries were exposed and cannulated for MAP monitoring and blood-letting. Blood was gradually removed until MAP dropped to 40mm Hg, which was maintained for 60min. Then same amount of HES (HES group) or Dextran (control group) was infused. The Kupffer cells were separated and purified before hemorrhagic shock (T0), at 12h (T1) 24h (T2) 48h (T3) and 72h (T4) after HES or DEX infusion, when the animals recovered from shock. Phagocytic activity of Kupffer cells (KC) was measured by counting the amount of Latex particles ingested by KC. Results At the same intervals (T1-4) there was no significant difference in phagocytic activity of KC between the two groups. There was no significant difference in phagocytic activity of KC between T0 (baseline) and T1-4 in both groups.Conclusions The phagocytic activity of Kupffer cells in not affected by removed of 20-30% blood volume which was replaced by same amount of HES.

5 cm).The survival rates and the diminished rates of tumors in size were analysed comparatively.Results For small hepatocellular carcinoma,the diminished rates of tumor's size were higher in group PEI than that in group TACE and group CST,and higher in group RF than that in group TACE(P0.05).For large hepatocellular carcinoma,the diminished rates of tumor's size were higher in group TACE and group CST than that in group RF(P

Eligible 112 children aged 4-12 years old were recruited and assigned to 2 groups with block random design.For the first treatment session,the subjects in group 1 received computer-controlled anaesthesia(CCA) with autiovisual distraction of video-eyewear system(ADVS) intervention based on the routine therapy,those group 2 received only CCA and routine therapy.For the second session,a crossover of intervention methods were conducted for the 2 groups.Before and after each session,pain intensity and dental anxiety of each group were evaluated.Results showed that the group receiving CCA-ADVS presented significantly lower pain intensity and dental anxiety than the group receiving CCA only(P＜0.05).Evident differences were detected in the assessment outcomes in each treatment session (P＜0.0001).The combination of CCA and ADVS can effectively reduce pain perception and dental anxiety of children in pediatric endodontic treatment.

It's very important to establish an evaluation system to match international standards for improving the medical education quality in China.This article reviews the global profile of evaluation process for higher education,and compares it with the current status in China.It introduces the characteristics and experiences from overseas as references to optimize our medical education evaluation system.