AIM: To study the adverse reactions of hydroxychloroquine (HCQ) in ophthalmology. 　METHODS: Thirty-nine patients treated with HCQ for more than six months were performed ophthalmic examinations including some specifie retinal function tests. 　RESULTS: There were 3 patients (8%) who presented the visual fields was minified. The visual acuity of one patient was decreased. The cumulative doses of HCQ were more than 100 g in this three patients. 　CONCLUSION: The adverse reactions of HCQ in ophthalmology are related with the cumulative doses of HCQ. The expression is that the visual fields and visual acuity are decreased.

Objective To explore whether the Kang Kefei and Tian Runmei′s diagnostic criteria (K-T criteria) is suitable for atopic dermatitis(AD). Methods 917 AD patients, whose diagnosis had been made with the Hanifin and Rajka criteria (H-R criteria) previously, were redignosed by K-T criteria. Their atopic history, and clinical fealures were analysed, too. Results 888 out of 917 patients(96.84%) were consistent with K-T criteria.763 patients (83.21%) had personal or family atopic history. The frequency of facial dermatitis was higher in infantile AD group than that in childhood AD group, adolescence AD group, and adult group. Whereas,the frequency of xerosis,ichthyosis,keratosis pilaris and orbital darkening was lower in infantile AD group than those in other groups. Conclusion Atopic history is an important factor in the diagnosisof AD. K-T criteria is practical and of value in the diagnosis of AD.

Objective To evaluate the clinical efficacy of endoscopic variceal ligation (EVL) combined with injection of tissue adhesive for esophageal and gastric varices bleeding.Methods Data of 452 patients with esophageal and gastric varices bleeding who received EVL and injection of tissue adhesive were retrospectively studied.Results The instant hemostatic rate was 100.0％ (145/145).Early rebleeding rate was 1.8％ (8/452).Incidence of early adverse reactions was 50.0％ (226/452).The total incidence rate of complications was 12.4％ (56/452).Efficiency and effectiveness of EVL were 32.5％ (145/446)and 40.4％(180/446) respectively.Efficiency and effectiveness of injection of tissue adhesive were 32.5％ (136/419) and 27.4％ (115/419) respectively.With an average of 18 months' follow-up (ranging from 9 to 37 months),the rate of rebleeding was 10.1％ (43/426),six-month and one-year survival rate was 97.9％ (417/426) and 89.9％ (383/426) respectively.Conclusion EVL combined with injection of tissue adhesive for esophageal and gastric varices is effective,convenient,and less invasive.They can be used not only for emergency hemostasis but also for secondary prophylaxis.

Surgical resection is considered to be the most effective therapy for hilar cholangiocarcinoma.Inadequate excision range is the main reason for recurrence after surgery.Extended radical resection provides better long-term survival,however,it may also increase the risk of liver failure because of the extensive hepatic resection.In present study,we showed a new operation which could excise enough length of bile ducts and avoid large volume hepatic tissue resection.The excision extension includes:segment Ⅰ,Ⅳb and partial Ⅳ,left,right and furcation of hepatic duct,extrahepatic ducts,skeletonization of hilar vessels,and dissection of at least second station lymph nodes.As the tissue resected resembles a dumbbell,this surgical technique is named dumbbell type radical resection.The operative indications include:(1) hilar cholangiocarcinoma,Bithmuth Ⅱ and Bithmuth Ⅲ with tumor limited in left or right hepatic ducts ; (2) Without portal invasion; (3) Without third station lymph node metastasis; (4) Without liver or distant organ metastasis.Twenty-three patients had undergone this operation sucessfully.Most patients have high total bilirubin levels (more than 300 μmol/L) and have not received percutaneous transhepatic cholangial drainage or biliary drainage.The average operation time was 355 minutes,and average volume of blood loss during operation was 350 ml.The total survival rate was 65.2％.One-year tumour free survival rate was 95.7％ (22/23),and three-year tumor free survival rate was 7/15.The results indicated that dumbbell type radical resection was feasible for hilar cholangiocarcinoam of Bismuth Ⅱ and Bismuth Ⅲ with tumor limited in left or right hepatic ducts.

Objective To investigate the efficacy of different radical surgical procedures for the treatment of hilar cholangiocarcinoma.Methods The clinical data of 207 patients with hilar cholangiocarcinoma who were treated at the Southwest Hospital from June 2007 to June 2012 were retrospectively analyzed.Local resection or hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅰ hilar cholangiocarcinoma; dumbbell type radical resection was applied to patients with Bismuth type Ⅱ hilar cholangiocarcinoma or some patients with type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma; hemihepatectomy or extended hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma.The patients were followed up every 3 months postoperatively till December 2012.All data were analyzed using the chi-square test or Fisher exact probability test,the survival curve was drawn by Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results Of the 207 patients,124 received radical resection,including 14 received local resection,23 received dumbbell type resection,87 received lobectomy + caudate lobectomy,49 received palliative resection; 34 received biliary drainage.Four patients died perioperatively.The incidences of complications of dumbbell type radical resection,left hemihepatectomy + caudate lobectomy,right hemihepatectomy + caudate lobectomy were 21.7％ (5/23),46.6％ (27/58) and 48.3％ (14/29),respectively.The incidence of complications after dumbbell type radical resection was significantly lower than left hemihepatectomy + caudate lobectomy and right hemihepatectomy + caudate lobectomy (x2 =4.42,3.90,P ＜ 0.05).One hundred and seventy patients were followed up.The median survival time of the 112 patients who received radical radical resection was 26.5 months,and the 1-,3-,5-year survival rates were 75.9％ (85/112),42.9％ (24/56) and 28.9％ (11/38),respectively.The median survival time of the 38 patients who received palliative resection was 8.5 months,and the 1-,3-year survival rates were 31.6％ (12/38) and 0.The survival time of 20 patients who received biliary drainage was 4.0 months,and the l-year survival rate was 0.The survival rate of patients who received radical resection was significantly higher than those who received palliative resection (x2=65.32,P ＜ 0.05).There was a significant difference in the survival rate between patients who received surgical treatment and those who received biliary drainage (x2=99.97,P ＜ 0.05).Of the 112 patients who received radical resection,the median survival time of 10 patients who received local resection of tumor was 47.0 months,the 1-year survival rate was 10/10,and 4 patients survived at the end of the follow-up; the median survival time of 23 patients who received dumbbell type radical resection was 32.0 months,and the 1-,3-year survival rates were 95.7％ (22/23) and 7/15,and the survival time of 6 patients was longer than 5 years; the median survival time of 54 patients who received left hemihepatectomy or extended left hemihepatectomy + caudate lobectomy was 27.6 months,and the 1-,3-year survival rates were 42.1％ (24/57) and 38.7％ (12/32),and the survival time of 9 patients was longer than 5 years,3 patients survived at the end of the follow-up ; the median survival time of 25 patients who received right hemihepatectomy or extended right hemihepatectomy + caudate lobectomy was 28.3 months,and the 1-,3-year survival rates were 45.8％ (11/24) and 6/15,and the survival time of 6 patients was longer than 5 years,2 patients survived at the end of follow-up.The median survival time of 35 patients (patients with Bismuth type Ⅰ,Ⅱ hilar cholangiocarcinoma and Bismuth Ⅲ a and Ⅲ b hilar cholangiocarcinoma which did not invade the secondary bile duct) who received hemihepatectomy + caudate lobectomy was 32.0 months,and the 1-,3-,5-year survival rates were 91.4％ (32/35),45.8％ (11/24) and 5/16,which were not different from the survival rate of patients who received dumbbell type radical resection (x2 =0.17,P ＞ 0.05).The 5-year survival rate of patients with lymph node metastasis was 4/19,which was significantly lower than 30.4％ (7/23) of patients without lymph node metastasis (x2 =23.40,P ＜ 0.05).Conclusion Joint lobectomy and standardized lymph node dissection could help to improve the efficacy of surgical treatment for patients with hilar cholangiocarcinoma.

Objective To explore the effect of lentiviral vector-mediated somatostatin (SST) expression on seizures induced by hippocampal kindling in rats.Methods Adult Sprague-Dawley rats were randomly divided into the sham group (Sham),epilepsy group (EP),Lenti-pSyn-EGFP (LV-EGFP) group and Lenti-pSyn-SST-2A-EGFP (LV-SST) group.The rats in LV-EGFP group were subsequently electrically hippocampal kindled and LV-EGFP (5 μl) was injected into dentate gyrus (DG).The rats in LV-SST group were kindled and LV-SST (5 μl) was injected into the dentate gyrus (DG),medial entorhinal cortex (MEC) or amygdala (Amy).Seizure severity was evaluated and immunohistochemical staining was employed to detect the expression of SST,neuron specific nuclear protein (NeuN) and microtubule associated protein 2 (MAP2).Results The current values to the first stage V seizure of LV-SST (DG) group,LV-SST (MEC) group or LV-SST (Amy) group ((143.8±3.8)μA,(142.5±4.1)μA,(142.5±5.3) μA,respectively) were significantly increased compared with that of epilepsy (EP) group ((136.3±5.3)μA),and V stage current values of LV-SST groups in each stimulation day were higher than that of EP group except the fifth stimulation day (P<0.05).After kindling,SST expression and NeuN-positive neurons of EP group and LV-SST groups were less than that of Sham group in CA1,CA3 and DG.SST and NeuN neurons loss in LV-SST groups were less than that of EP group (P<0.05) and MAP2 immunohistochemistry stainings in LV-SST groups were higher than that in EP group.Conclusion Lentiviral vector-mediated somatostatin expression suppresses seizures and can rescue the neuronal damage of seizure induced by kindling in hippocampus,which may provide a new method of gene therapy for temporal lobe epilepsy.

Objective To summarize our experience in performing modified hepatic outflow tract reconstruction in liver transplantation. Methods The clinical data of 142 cases of liver transplantation from Jan 1999 to Aug 2003 were analyzed retrospectively. Results Sixteen patients died postoperatively, mortality rate of this group was 11.27%. No hepatic outflow obstruction developed in this group. Two postoperative recipients have survived for more than four years, five recipients have survived for more than three years, thirty four for more than two years, thirty eight for more than one year. Conclusion This procedure has the advantage of less technique-related complications and time-saving.

Objective To describe the hemodynamic changes during piggyback liver transplantation (PBLT), and to analyze the hemodynamic correlation with various degrees of cirrhosis according to Childpugh classification. Methods Between March 1999 and June 2004, 180 patients underwent PBLT procedure in our institution, and 95 cases were selected and divided according to Child classification. The intraoperative hemodynamics of different time points were retrospectively analyzed, including mean artery pressure (MAP), heart rate (HR), central vein pressure (CVP) and mean pulmonary artery pressure (MPAP). Results Hemodynamic changes were minimal before and during anhepatic phase in all the patients. At reperfusion, a hemodynamic disturbance occurred featured by decrease of MAP and increase of MPAP. Comparison between different Child class showed that in the Child C group, MAP were lower and HR were higher before new liver phase, while CVP and MPAP were higher during new liver phase. Conclusion Hemodynamic changes were minimal before and during anhepatic phase for PBLT, while they were more severe during reperfusion, and they also correlates with the different Child class before transplantation. The more severe of the cirrhosis before transplantation according to Child classification, the greater hemodynamic changes during the operation.

Objective To investigate an effective endoscopic management of biliary anastomotic stric-tures (AS) following orthotopic liver transplantation (OLT) and to evaluate the factors which may effect the ontcome. Methods Sixty-five patients, who were diagnosed as AS 3 months after OLT, underwent ERCP. Af-ter adequate dilation of the narrowing bile ducts, plastic stents, as many as possible, were inserted across the strictures and kept in place for at least six months. Results A total of 90 consecutive endoscopic procedures were performed in 65 patients. Before stents placement, the strictures were dilated by catheter or balloon (di-ameter range: 6-10 mm), or not dilated, according to the status of the bile ducts. An average of 3 (ranging from 2 to 6) plastic stents were placed with mean total size of 22.8 F (range 14-42 F), and the stents were kept for 8. 0 months on average (range 0.2-37.8 months). Of 90 procedures of stents placement, 54 (60%) were followed by stents removal and cholangiography, which confirmed stricture resolution in 26 (48.1%). The stricture resolution rate was 81.0% (17/21) in patients who underwent balloon dilation followed by more than 3 stents (> 21 F) for at least 3 months. Stricture re-occurred in 3 patients after stents removal, in whom stents were kept less than six months. Conclusion Endoscopic sequential intervention is effective for post-OLT biliary strictures according to the stage and grade. Radical dilation with maximal stenting can lead to complete resolution of AS. To achieve better result, if possible, balloon dilatation followed by three or mere endoprothe-ses (of at least 21 F) sustaining for more than 6 months is necessary.

OBJECTIVETo observe the clinical effect of Yangyin Yiqi Huoxue Recipe (YYHR, the basic recipe of Yangyin Tongnao Granule) in treatment of ischemic stroke patients of deficiency of qi and yin syndrome (DQYS) and static blood obstructing collaterals syndrome (SBOCS).

METHODSTotally 312 patients were assigned to the control group (86 cases) and the treatment group (226 cases) using strati- fied randomized allocation method. Patients in the treatment group were treated with modified YYHR, while those in the control group took Xueshuan Xinmaining. The treatment course was 4 weeks for all. Constituent ratios of the acute stage and the recovery stage of DQYS and SBOCS and their complicated syndromes were observed in the two groups. Changes of the clinical curative effect, clinical symptoms integral, whole blood viscosity ratio, plasma viscosity ratio, hematocrit, erythrocyte sedimentation rate (ESR), total cho- lesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were detected in the two groups before and after treatment.

RESULTSThere was statistical difference in constituent ratios of the acute stage and the recovery stage of DQYS SBOCS and its complicated syndromes between the two groups (P < 0.01). DQYS and SBOCS was basic syndrome types of the two groups. The cured and markedly effective rate was 71.24%(161/226) in the treatment group and 43.02% (37/86) in the control group. The total effective rate was 91.15% (206/226) in the treatment group, higher than that of the control group (76.74%, 66/86) with statistical difference (P < 0.01). There was statistical difference in the clinical symptoms integral, whole blood viscosity ratio, plasma viscosity ratio, hematocrit, ESR, TC, TG,HDL-C, and LDL-C (P < 0.05, P < 0.01).

CONCLUSIONSSymptoms of ischemic stroke patients could be improved by modified YYHR. Indices such as the whole blood viscosity, plasma viscosity ratio, hematocrit, ESR, abnormal metabolism of blood lipids were also significantly improved. Pathological changes of blood stasis induced by qi-yin deficiency exist in ischemic stroke patients, and DQYS and SBOCS were basic syndrome types.

Aged ; Biomedical Research ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hematocrit ; Humans ; Male ; Middle Aged ; Qi ; Stroke ; drug therapy ; Triglycerides ; blood ; Yin Deficiency ; therapy