AIM: To investigate the efficacy of 23G minimally vitrectomy without irrigation in cataract phacoemulsification and trabeculectomy of malignant glaucoma, and to analyze such compound operative procedures for phakic malignant glaucoma.
●METHODS:A total of 21 phakic malignant glaucoma patients (21 eyes) underwent anterior vitrectomy without irrigation by using 23G vitrectomy. During surgical course phacoemulsification with anterior and posterior continuous circular capsulorhexis, trabeculectomy combined with iridectomy would be completed. lntraocular pressure, anterior chamber depth changes and postoperative complications were observed after the operation.
●RESULTS:ln the three-month follow-up, intraocular pressures were reduced from ( 57. 18 ± 6. 18 ) mmHg to (16. 15 ± 2. 43 ) mmHg, there was statistical difference compared with pre - operation ( P < 0. 001 ). The preoperative anterior chamber depth (ACD) was (0. 88± 0. 25) mm, the postoperative ACD was (2. 44±0. 37) mm 3mo later, there were significant difference (P<0. 001). The best corrected visual acuity improved significantly, no serious postoperative complication appeared.
● CONCLUSION: The compound surgical method of anterior vitrectomy combined with phacoemulsifier and trabeculectomy can effectively treat phakic malignant glaucoma. Early diagnosis and early compound surgery may effectively reduce the intraocular pressure of malignant glaucoma.

Objective To investigate the therapeutic effect of different doses of caffeine on premature apnea.Methods 80 patients with apnea were divided into observation group and control group,each group in 40cases.The two groups applicated caffeine citrate.The control group received the basal dose, first application of 20 mg/kg, intravenous injection, intravenous injection of 5 mg/kg after 24 h.The observation group was treated with intravenous injection of 10 mg/kg after 24 h.The treatment period was 7 d.The therapeutic effect, blood gas and oxygenation index and adverse reactions were observed in the two groups.Results The effective rate of the observation group was 92.5%,which was significantly higher than 75.0% of the control group(x2=4.501,P<0.05).After treatment, the duration[(9.05±1.82)s vs (13.53±2.63)s]and lost time[(2.52±0.94)h vs (3.42±1.13)h]of apnea in the observation group were longer than those of the control group.The number of seizures[(22.15±4.16) vs (33.53±8.48)]was less than that of the control group,the differences were statistically significant(t=8.767,5.434,9.231,all P<0.05).After treatment, PaO2[(84.74±9.74)mmHg vs (71.46±8.53)mmHg],PaCO2[(42.62±4.15)mmHg vs (48.54±5.18)mmHg]and PaO2/FiO2[(221.52±26.51)mmHg vs (197.76±21.71)mmHg]in the observation group were significantly better than those of the control group(t=7.574,4.765,8.643,all P<0.05).The incidence rate of adverse reactions include tachycardia, hyperglycemia, hypoglycemia and restlessness had no significant difference between the two groups (15.0% vs 10.0%, P>0.05).Conclusion In the treatment of premature apnea, advanced caffeine citrate treatment can better improve the clinical symptoms and blood gas index, the curative effect is reliable.

Objective To study the association between serum interleukin-33 (IL-33) level and human stromelysin-2 (ST2) level in patients with rheumatoid arthritis (RA) associated with interstitial lung disease (RA-ILD) and its correlation with lung function and other laboratory parameters.Methods Two hundred and forty-five newly diagnosed RA patients during March 2012 to March 2013 in the in-patient and out-patient clinic of the First Affiliated Hospital of Liaoning Medical College were enrolled into this study.Patients were further divided into RA group (n=187) and RA-ILD group (n=58).Sixty subjects who came to the hospital for routine health check-up was composed of the normal control group.The clinical data of the two groups and controls were collected and their serum IL-33 and ST2 concentrations were measured.The t test was used to compare the difference between the two groups.Multiple variance analysis was used to com-pare the difference between groups.Pearson's correlation analysis was applied to explore the relationship between IL-33 concentrations and related variables.Results ① This study showed that the prevalence of RA associated interstitial lung disease was 23.7％(58/245).② The concentration of IL-33 [(746±43) pg/ml] and ST2 [(3413±169)pg/ml] of the RA-ILD group was significantly higher than that of the RA group [(433±42) pg/ml,(1500±147) pg/ml] (P＜0.01).③The vital capacity (VC％),forced vital capac-ity (FVC％),maximal midexpiratary flow curve (MMF％) and carbon monoxide diffusing capacity (DLCO) of the RA-ILD group were significantly lower than those of the RA group.④ The serum level of IL-33 was negatively correlated with that of RF and ACPA (IL-33 and RF,r=0.82,P＜0.01; IL-33 and ACPA,r=0.55,P＜0.01).Serum level of IL-33 was negaitively correlated with DLCO (r=-0.80,P＜0.01).Conclusion IL-33 participates in the pathogenesis of RA; and may be involved in the pathogenesis of RA-ILD.

Objective To investigate the pathological features,diagnosis and treatment of primary malignant melanoma in esophagus (PMME).Methods The clinical data of 3 patients with PMME who were admitted to the Beijing Friendship Hospital from January 2008 to June 2009 were retrospectively analyzed.All the patients received esophageal barium radiography,electronic fiberesophagoscopy,esophageal endoscopic ultrasonography,computed tomography,and underwent surgery.Adjuvant therapy and immunotherapy were applied postoperatively.Results The results of barium radiography showed irregular filling defect presentation in the distal esophagus.The results of endoscopy showed a purple black tumor with a length of 3-8 cm in the esophagus.The results of endoscopic ultrasonography showed that the tumor was derived from the mucosal layer with low echo density.The results of computed tomography showed thickness of the lower segment of the esophagus.All the 3 patients received left thoracic approach esophagectomy and esophagogastrostomy.Histopathology and immunohistochemistry confirmed malignant melanoma.The expressions of Mart-1,HMB-45 and S-100 antigen were positive.The survival time of 2 patients was longer than 3 years,and 1 patient died of metastasis 6 months after operation.Conclusions PMME is a kind of rare and malignant tumor with dismal prognosis.Surgical management is the first choice,adjuvant chemotherapy and immunotherapy are hopeful to increase the survival time of the patients.

BACKGROUND:Airway epithelial regeneration can effectively inhibit submucosal hyperblastosis and the occurrence of obliteration. Studies demonstrated that ventilation could accelerate the regeneration of airway epithelium. OBJECTIVE:To establish and improve an orthotopic tracheal transplantation model and to further observe the effects of ventilation on trachea in alogeneic mice. METHODS:C57BL/6 mouse's tracheal served as donor, and BALB/c mouse's tracheal as recipient. This experiment contained two groups. In the experimental group, the membranous part of trachea was longitudinaly dissected in two donors and sutured into an enlarged trachea, which was implanted in the recipient. In the control group, donor's trachea was implanted into the recipient in situ. Samples were obtained and detected at 28 days after surgery. RESULTS AND CONCLUSION: Hematoxylin-eosin staining results demonstrated that compared with the control group, wel-differentiated ciliated epithelium was visible in the epithelial lamina of tracheal lumen, accompanying a few non-ciliated single or stratified squamous epithelium, mild submucosal fibrosis and inflammatory cel infiltration. Morphological analysis revealed that ciliated epithelial proportion in the experimental group was higher than in the control group (P < 0.05). The ratio of lamina propria to the tracheal cartilage, submucous fibrous tissuearea and the degree of lymphocyte infiltration were lower in the experimental group than in the control group (P < 0.05). Immunohistochemical staining demonstrated that the transplanted tracheal epithelium in both groups was recipient epithelial phenotype. Results verified that a modified orthotopic tracheal transplantation model was successfuly established. The increased ventilation of the tracheal alografts can accelerate the differentiation of tracheal epithelium. The wel-differentiated airway epithelium inhibited the proliferation of fibroblast.

Objective To explore the clinical significance of dyslipidemia in patients with systemic lupus erythematosus (SLE).Methods By independent-samples t test,serum lipid level was compared between 326 SLE patients and 300 healthy controls.The total cholesterol (TC),triglyceride (TG),lowdensity lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were partially compared in subgroups of SLE patients.The correlation of serum TC,TG,LDL-C and HDL-C with clinical manifestations and laboratory findings in SLE was analyzed by Pearson or Spearman correlation analysis.Results ①The serum levels of TC [(3.8±1.5) mmol/L],TG [(2.1±1.6) mmol/L] and LDL-C [(2.1±0.9) mmol/L] were significantly higher in SLE group than those of the control group [(3.4±0.6),(0.8±0.4),(1.9± 0.5) mmol/L],and the serum level of HDL-C [(1.2±0.9) mmol/L] was significantly lower in SLE group than that of the control group [(2.0±0.5) mmolFL] (t=4.953,P=0.000; t=14.569,P=0.000; t=3.204,P=0.001; t=-14.335,P=0.000].② The serum levels of TC [(4.0± 1.7) mmol/L],TG [(2.5± 1.7) mmol/L] and LDL-C [(2.2±1.0) mmol/L] were significantly higher in LN group than those of the non-LN group [(3.6±1.0),(1.6± 1.0),(1.9±0.7) mmol/L; t=2.646,P=0.009; t=6.292,P=0.000; t=3.261,P=0.001].③ The serum level of TG [(2.2±1.6) vs (1.8±1.4) mmol/L] was significantly higher in SLE patients with hypocomplementemia than that of the normal ones (t =2.098,P=0.038).The serum level of HDL-C [(1.1 ±0.4) vs (1.6± 1.7) mmol/L] was significantly lower in SLE patients with hypocomplementemia than that of the normal ones (t=-2.375,P=0.020).④ The serum level of TG [(2.3±1.7) vs (2.0±1.4) mmol/L] was significantly higher in anti-dsDNA antibody positive patients than that of negative ones (t=1.989,P=0.048).The serum level of HDL-C [(1.5± 0.4) vs (1.4±1.2) mmol/L] was significantly lower in anti-dsDNA antibody positive patients than that of negative ones (t=-2.979,P=0.003).⑤ The lipid level was correlated with the clinical manifestations and laboratory findings in SLE patients.Conclusion Dyslipidemia exists in patients with SLE and has close correlation with LN,hypocomplementemia and positive anti-dsDNA antibody.

Medical genetics is one of the important basic courses in medical education. The teaching reform in course content, teaching method and experimental teaching was carried out to arouse their enthusiasm in study, cultivate their capabilities of analyzing of medical practice problem.

Objective To investigate the clinical value of perforin and granzyme B expression in peripheral blood lymphocytes and diagnosis of acute rejection in renal transplantation. Methods Sixty-seven recipients of renal allograft were included in the study. The expression of perforin and granzyme B of peripheral blood lymphocytes was studied by quantitative reverse transcription polymerase chain reaction (RT-PCR). The recipients were divided into four groups, including 7 cases of acute rejection as group 1, 8 cases of delayed graft function as group 2, 27 cases of stable function as group 3, 25 cases of long-term survival as group 4. Results The expression of perforin and granzyme B in group 1 was significantly higher than that of the other three groups (P

Objective To investigate the effect of perforin and granzyme B in peripheral blood lymphocytes during acute rejection in renal transplantation.Methods Sixty-seven recipients of renal allograft were involved in the study.The recipients were divided into four groups: group 1 with 7 cases of acute rejection,group 2 with 8 cases of delayed graft function,group 3 with 27 cases of stable function and group 4 wih 25 cases of long-term survival.The expressions of perforin and granzyme B of peripheral blood lymphocytes were studied by quantitative reverse transcription polymerase chain reaction(RT-PCR).Results The expressions of perforin and granzyme B in acute rejection group were significantly higher than those of the other three groups(P

Objective To analyze the features of onset, clinical pathological characteristics about the primary bladder mucinous adenocarcinoma.Methods From January 1990 to June 2015, we retrospectively reviewed the data from 15 patients diagnosed as primary bladder mucinous adenocarcinoma, including 10 male patients and 5 female patients.Their mean age was 58 years old, ranged from 41 to 78 years old.Among the fifteen patients, the initial symptoms included hematuria in 13 cases, lower abdominal pain in 1 case and urinary irritation symptom in 1 case.The ultrasound and CT scan revealed bladder tumors, which the size ranged from 2 to 6 cm.The location of bladder tumors included front wall in 12 cases, trigone zone in 2 cases and top wall in 1 case.Nine cases was suspected as tumor from urachal remnants.Eleven patients underwent partial cystectomy, three patients accepted the radical cystectomy and one case accepted transurethral resection of bladder tumor (TURBT).Result Pathological diagnosis was bladder mucinous adenocarcinoma in all patients, including nine from urachal remnant and the others from urothelimn.The tumor exhibited the mushroom liked prominence, which was associated with surface ulceration and infiltrated into the depth of bladder.Meanwhile, it was covered with thick mucinous substances.The histologic examination revealed the presence of andenoid structure, composed by various degree of diferenfiated mucinous cells.In cases with adenocarcinomas from urachus, the residue of urachal tissue could be noticed.The bladder mucous was intact or ulcerated.No sign of metaplasia was observed.In the pathological diagnosis, the classification included grade Ⅲ in 3 cases, grade Ⅱ in 7 cases and grade Ⅰ in 5 cases.Ten persons reported the information of the follow up.Eight of them, whose tumor originated from urachus, accepted bladder-sparing surgery.One died from acute myocardial infarction after 23 months postoperatively.And one died from cerebral hemorrhage 45 months postoperatively.The others have been followed up from 8 to 65 months with no sign of recurrence.In two cases with urothelial carcinoma, one was found the new urothelial carcinoma 50 months after TURBT and one died from cancer metastasis 29 months after partial cystectomy.Conclusions Primary mucinous adenocarcinoma of the bladder possess the relatively high malignant tendency.The hematuria is the main initial symptoms.The histologic examination revealed the presence of different differentiated mucinous cells and formed the andenoid structure.The case with urachal remnant adenocarcinoma has the better prognosis than other types.