AIM: To observe the clinical effect of combined cataract and primary open-angle glaucoma underwent phacoemulsification and glaucoma drainage device implantation. ·METHODS: We selected in our hospital from January 2014 to February 2016, 42 cases (42 eyes) with primary open-angle glaucoma with cataract. According to random number table method, all of the patients were randomly divided into two groups, control group and study group. In control group, 21 patients ( 21 eyes ) underwent trabecular resection combined phacoemulsification;in study group patients, 21 patients ( 21 eyes ) , underwent EX-PRESS glaucoma drainage device combined phacoemulsification. Compared parameters included postoperative complications and filtering bleb, visual acuity, intraocular pressure ( IOP ) and other clinical indicators between two groups. ·RESULTS: Preoperative IOP of two groups was no significantly different (P>0. 05). Postoperative IOP at each time point was significantly lower than before treatment (P<0. 05). At 1d, 1 and 4wk after treatment, IOP of the study group was significantly lower than the control group (all P<0. 05); at 12wk after treatment, IOP of the two groups was not significantly different ( P> 0. 05). At 12wk after treatment, surgical success rate of study group was 95%, significantly higher than that of control group 71% (P<0. 05). The postoperative best corrected visual acuity of two groups was no significantly different (P>0. 05). At 12wk after treatment, 21 patients in study group were shown as functional filtering bleb, while in the control group 18 cases was functional filtering bleb. ·CONCLUSION:Using EX-PRESS glaucoma drainage device combined with phacoemulsification in treating cataract with primary open-angle glaucoma is reliable, the curative effect is better than that by trabeculectomy combined with phacoemulsification treatment.

Objective To summarize the safety and efficacy of Sunitinib in the treatment of metastatic renal clear cell carcinoma. Methods Fifteen patients with clear cell metastatic RCC were treated with Sunitinib,with 11 males and 4 females,aged from 26 to 74 years with median age of 55 years.Thirteen cases of 15 were T3 to T4 stage,and 8 cases underwent radical nephrectomy,while 5 other cases underwent renal biopsy with the pathological diagnosis of renal cancer.The other two cases (one man and one woman)with the solitary kidney renal cell carcinoma ( stage T1a) and renal insufficiency,were diagnosed as metastatic renal cell carcinoma by biopsy.Sunitinib monotherapy was administered by the regimen of 6 weeks per cycle with daily oral Sunitinib 4 weeks,followed by 2 weeks off ( from 1 - 10 cycles).Response was evaluated by RECIST.Renal tumor was 9.52 ± 3.3 cm in diameter at baseline,and the assessment of metastases included retroperitoneal lymph nodes (6 cases),mediastinal lymph nodes (3 cases),brain (2 cases),lung (6 cases),bone (2 cases) and liver (2 cases).Karnofsky score,tumor changes,adverse events and the survival of each patient was assessed and recorded. Results The follow-up duration was from 1.5 - 15months,with median follow-up of 6 months,and tumor response was evaluated by RECIST.Seven of 15 patients (46.7％) treated with Sunitinib achieved partial responses (PR),7 patients (46.7％) demonstrated stable disease (SD),and 1 patient (6.7％) developed progressive disease (PD) during the follow-up.Objective Response Rate (ORR) was 46.7％,PR + SD was 93.3％,6 months PFS was 93.3％,and median PFS was 12 months,respectively.Renal tumor was 8.7 ± 4.0 cm in diameter after therapy.Two PR patients with the obvious effectiveness had experienced progressed hypertension,and one cases with hypertension that could be controlled below 140/90 mm Hg ( 1 mm Hg =0.133 kPa) by a single drug before treatment,showed increased blood pressure ( ＞ 160/105 mm Hg) following the second cycles treatment,who were administered increased dosage and combination therapy.The other case without history of hypertension,showed high blood pressure ( ＞ 150/100 mm Hg) in the third cycle,and could be controlled well by antihypertensive drugs.Fortunately,the tumor of these two cases reduced obviously by more than 50％. 1/2 adverse reactions of 12 cases:yellowing of the skin and yellow sweat ( 12 cases,80％ ),fatigue ( 12 cases,80％ ),4 cases of hypothyroidism (26.7％),bilirubin and triglyceride levels elevated in 7case (46.7％); Four cases showed 3/4 degree adverse events with the emergence of gastrointestinal bleeding in one case secondary to platelets reduction (6.7％).Three cases (20％) showed serious fatigue,nausea,vomiting and severe hand-foot skin reaction. Conclusions Sunitinib is recommended for the treatment of metastatic renal clear cell carcinoma with good efficacy and safety.

OBJECTIVEIt has been proposed that aberrant immunity of local bowel mucosa may cause ulcerative colitis (UC) and the tumor necrosis factor-alpha (TNF-alpha) and nuclear factor-kappa B (NF-kappa B) may play a role in the development of this disease. To investigate the role of TNF-alpha and NF-kappa B in childhood UC, the expression of TNF-alpha and NF-kappa B in the bowel mucosa and their relationship were studied.

METHODSUsing anti-CD68, anti-TNF-alpha and anti-NF-kappa Bp65 antibodies, the cytokine immunoreactivities in the bowel mucosa of 39 cases of childhood UC (active UC: n = 21, non-active UC: n = 18) were detected by immunohistochemistry. The control specimens of normal bowel mucosa were collected from 7 cases with colorectal polyp or abdominal pain by sigmoidoscopy.

RESULTSThe numbers (median: interquartile range) of CD68(+) cells, TNF-alpha(+) cells and NF-kappa Bp65(+) cells were 44.0 (31.5 - 48.2), 42.7 (19.5 - 65.0) and 50.7 (30.0 - 58.0) in the active UC mucosa, and were 9.2 (7.9 - 16.6), 5.5 (2.5 - 9.1) and 4.2 (3.0 - 8.4) in non-active UC mucosa, and 5.3 (4.3 - 8.7), 3.0 (0.0 - 6.3) and 3.3 (0.0 - 4.0) in the control mucosa, respectively. The levels of CD68, TNF-alpha and NF-kappa Bp65 expressions in the active UC were significantly higher than those in the non-active UC (P < 0.001) and the controls (P < 0.001). The expression level of CD68 in non-active UC was much higher than that in the controls (P = 0.008). Using the correlation analysis, a positive correlation between TNF-alpha and NF-kappa B activation was found (r = 0.885, P < 0.001).

CONCLUSIONSMacrophages TNF-alpha and NF-kappa B may play an important role in the pathophysiologic mechanism of childhood active UC. The activation of NF-kappa B may be associated with the release of TNF-alpha.

Adolescent ; Antigens, CD ; analysis ; Antigens, Differentiation, Myelomonocytic ; analysis ; Child ; Child, Preschool ; Colitis, Ulcerative ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Infant ; Male ; NF-kappa B ; analysis ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVEDuodenal salami ulcer is a common disease found on routine endoscopic examination in children. The purpose of the study was to explore the characteristics and the clinicopathological features of duodenal salami ulcer in children and to deepen the understanding of duodenal salami ulcer.

METHODSThe endoscopic results of 117 cases with the duodenal salami ulcer were analyzed. The specimens of gastric antrum and duodenal bulb were subjected to HE and Giemsa staining and were examined for any alteration in histopathology and infection with Helicobacter pylori (Hp). The duodenal mucosa was stained with AB (pH 2.5)/PAS in order to diagnose the duodenal metaplasia.

RESULTSThe major endoscopic finding was a kind of hoarfrost, which was dotty or flaky, covered on the hyperemic and edematous mucosa. The detection rate of this change was 2.29% (117/5 106) of all the endoscopic examinations in children and the rate among cases with duodenal ulcer was 49.2% (117/238). The histopathology was characterized by a heavy infiltration of mainly lymphocytes, plasmocytes and neutrophilic granulocytes, frequently accompanied by superficial erosion. Sixty-one cases were pathologically diagnosed as chronic active duodenitis, superficial erosion in 45; chronic duodenitis in 50; eosinophilic duodenitis in 6. Detection rate of Hp in gastric antrum was 58% (68/117) of all cases. Detection rate of Hp infection and gastric epithelium metaplasia in duodenal bulb was 11.1% (13/117) and 31.1% (37/117), respectively. However, detection rate of Hp in gastric antrum was 25.0% (1 203/4 810) in 4 810 cases of normal duodenal bulb and chronic duodenitis in the same period. Detection rate of Hp in duodenal bulb was 0% and the detection rate of gastric epithelium metaplasia in duodenal bulb was 2.7% (128/4 810). All these detection rates were much higher than those of the specimens collected during the same period with normal duodenal bulb and chronic duodenitis (P < 0.001). Twenty-one cases were reexamined by endoscopy after having been treated with antacids or antacids and antimicrobial agents for 4 weeks. The lesions were healed up and no scars were found.

CONCLUSIONDuodenal salami ulcer in children had a special manifestation of duodenal inflammation or erosion but not a real ulcer. It was caused by the Hp infection in gastric antrum or duodenal bulb and the increase of gastric acids. The therapeutic principles were antacid and antimicrobial agents. The prognosis was good.

Adolescent ; Child ; Duodenal Ulcer ; complications ; pathology ; Duodenum ; pathology ; Female ; Helicobacter Infections ; complications ; Humans ; Male ; Pyloric Antrum ; pathology

Objective To analyze the efficacy and safety of hypofractionated stereotactic radiotherapy ( FSRT ) combined with temozolomide ( TMZ ) for large brain metastases ( BMs ) in a prospective phaseⅡclinical trial.Methods From 2010 to 2015, a total of 33 patients were enrolled as subjects.The median Karnofsky Performance Status scores before and after treatment were 70 and 80, respectively.The major primary tumor was non-small cell lung cancer (57.6%).The brain metastasis had a diameter of≥3 cm or a volume of ≥6 cm3 .The radiation dose was 52 Gy in 13 fractions or 52.2 Gy in 15 fractions.Patients received TMZ at a dose of 75 mg/m2 per day concurrently.The radiotherapy was followed by 6 cycles of adjuvant treatment with TMZ (150 mg/m2, days 1-5, 28 days per cycle).Patients were reexamined by magnetic resonance imaging ( MRI) during the treatment.The radiation field would be shrunk if the gross target volume ( GTV) was reduced by≥20%.The treatment outcomes were evaluated by MRI at 2-3 months after treatment.Results The total numbers of tumors and GTVs were 95 and 38, respectively. Twenty-four (63%) out of the 38 GTVs had a volume larger than 10 cm3 and the median GTV was 15.3 cm3 (5.7-142.8 cm3).Twenty-two (67%) out of the 33 patients achieved field shrinking during the treatment, and the median reduction rate of GTV was 44%( 21%-88%) .The median total dose was 59.5 Gy, and 100%and 21.2%of patients completed the concurrent and adjuvant treatment with TMZ, respectively.In all patients, the overall response rate was 97.0%;the 1-year local control, intracranial progression-free
survival, and overall survival rates were 97%, 70%, and 62%, respectively;the median survival time was 15.3 months.The main adverse reactions were grade 1-2 nausea and vomiting.One patient got grade 3 liver function impairment.Conclusions FSRT combined with TMZ is a safe and effective approach for treating large BMs.More than 50%of patients can achieve field shrinking to shorten treatment duration and reduce toxicity.Clinical Trial Registry ClinicalTrials.gov,registration number:NCT02654106.

OBJECTIVETo discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures.

METHODSFrom January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score.

RESULTSNo infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case.

CONCLUSIONSArthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.

To investigate the changes in bcl-2, bax expression and neuron apoptosis in the hippocampus after the blockade of cervical lymphatics, the model of lymphostatic encephalopathy was established by occluding and removing both the superficial and deep cervical lymph nodes in rats. The animals were sacrificed at 1, 2, 3, 5, 7 and 14 d after operation. H and E staining was used to observe the structure of brain tissues and TUNEL staining was used to detect in situ cell apoptosis in the hippocampus. The expression of bcl-2 and bax in the hippocampus were examined by RT-PCR. The results showed that cerebroedema appeared at day 2 and was most serious at day 5 after the blockade of cervical lymphatics. The number of TUNEL positive cells began to increase at day 2 and reached the maximum at day 5. The expression of bax began to increase at day 1 and reached the maximum at day 2. The expression of bcl-2 began to decrease at day 1 and dropped to the minimum at day 5. The items mentioned above recovered to control level at day 14. These results suggest that lymphostatic encephalopathy following the blockade of cervical lymphatics result in changes in bcl-2 and bax expression in the hippocampus and that apoptosis is the main form of neuron death.
Animals ; Apoptosis ; physiology ; Female ; Hippocampus ; metabolism ; pathology ; Lymph Node Excision ; Lymphatic System ; physiology ; Male ; Neck ; Neurons ; cytology ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Wistar ; bcl-2-Associated X Protein ; genetics ; metabolism

Objective To investigate the clinical efficacy of electrothermal acupuncture plus joint mobilization in treating knee osteoarthritis.Methods One hundred patients with knee osteoarthritis were randomized to treatment and control groups, 50 cases each. The control group received Maitland's technique and the treatment group, electrothermal acupuncture in addition. The Osteoarthritis Index score was recorded and cytokines (IL-1, IL-6 and TNF-α) contents were measured in the two groups before and after four weeks of treatment. The clinical therapeutic effects were compared between the two groups.Results The total efficacy rate was 91.5％ in the treatment group and 80.0％ in the control group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in the WOMAC score and cytokines in the two groups (P<0.01,P<0.05). There were statistically significant post-treatment differences in the WOMAC score and cytokines between the treatment and control groups (P<0.05).Conclusion Electrothermal acupuncture plus joint mobilization is an effective way to treat knee osteoarthritis.

OBJECTIVE: To observe the changes of distortion product otoacoustic emissions (DPOAE) in the patients with iron deficient anaemia (IDA). METHOD: Sixty cases who were taken health physical examination at ZhaBei District Central Hospital were divided into two groups, the normal group (30 cases, 60 ears) and the IDA group (30 patients, 60 ears) depend on the results of examination of hemoglobin and serum ferritin. The changes of DPOAEs at 4 kHz were observed. RESULT: A statistically significant decrease of DPOAE threshold level compared with the normal controls was seen at 4 kHz in the patients with IDA. CONCLUSION The decreased threshold level of DPOAE at 4 kHz in IDA patients should relate to sensorineural hearing loss directly.
Adolescent ; Adult ; Aged ; Anemia, Iron-Deficiency ; blood ; physiopathology ; Audiometry, Pure-Tone ; Auditory Threshold ; Case-Control Studies ; Cochlea ; physiopathology ; Female ; Ferritins ; blood ; Hemoglobins ; analysis ; Humans ; Male ; Middle Aged ; Otoacoustic Emissions, Spontaneous ; Young Adult

The purpose of the present study was to investigate the anti-proliferative and apoptotic effects of tetramethypyrazine(TMP)on HepG2 and to elucidate the underlying mechanisms. CCK-8 was introduced to analyze the HepG2 cells proliferation. Cell apoptosis, mitochondrial membrane potential(ΔΨm)and cytochrome C were measured by high content screening(HCS). Cleaved-caspases protein expression was detected by Western blot. CCK-8 assay indicated that TMP significantly inhibited HepG2 cells proliferation in dose-dependent manner compared with the control group. Moreover, it was found that TMP could also induce HepG2 cell apoptosis, directly increase the release of cytochrome C, decrease ΔΨm and increase cleaved-caspase-3 and cleaved-caspase-9 protein expression. TMP may inhibit cell proliferation and induce cell apoptosis by stimulating the mitochondrial pathway apoptosis in HepG2 cells.