Central serous chorioretinopathy (CSC) is characterized by serous detachment of the sensory retina as a consequence of the focal leakage of fluid from the choriocapillaries to subretinal space through a defect of the retinal pigment epithelium(RPE). The exact cause of CSC is not well unknown. Psychological stress is thought to contribute to CSC, but the physiologic mechanisms are unclear. It is hypothesized that psychological stress can induce CSC through the mechanism of the hypothalamic-pituitary-adrenal (HPA) system. Psychological stress can adversely affect HPA axis and causes glucocorticoid levels to elevate. Increased glucocorticoids constrict choroid vessels, which leads to ischemia of choroids and damage vascular endothelial cells, thus causing vasopermeability to increase. RPE dysfunction will occur as a result of abnormalities in the choroidal circulation. The large molecules including protein may enter the subretinal space through the damaged vessels and RPE.

AIM: To investigate the clinical efficacy and safety of intravitreal injection of triamcinolone combined macular grid photocoagulation treatment for macular edema.
METHODS: Totally 150 cases (150 eyes) with macular edema in our hospital from July 2009 to November 2013 were selected, which were randomly divided into study group (75 cases, 75 eyes) and control group (75 cases, 75 eyes) . The cases in control group were treated with macular grid photocoagulation treatment, those in the study group used triamcinolone acetonide combined macular grid photocoagulation treatment. Best corrected visual acuity ( BCVA ) , parallel optical coherence tomography ( OCT) and fundus fluorescein angiography (FFA) were detected before treatment, after treatment 7d, 1, 3, and 9mo.
RESULTS:After the treatment, patients' vision were significantly improved in two groups (P<0. 05). In the study group 7d, 1, 3, and 9mo after operation, the visual acuity was better than the control group and preoperative (P<0. 05); fovea macular neurosensory layer thickness decreased significantly (P<0. 05). In the control group, the point omentum macular neurosensory retinal thickness was not statistically significant at 7d, 1, 3, and 9mo after operation compared with before treatment (P>0. 05). Fovea macular neurosensory retinal thickness in the study group was significantly lower than that in control group (P<0. 05). Intraocular pressure of 7 cases in the study group increased slightly, and were normal after treatment.
CONCLUSION: Triamcinolone acetonide combined macular grid photocoagulation treatment is accurate, can effectively improve the visual acuity, reduce macular edema, it is safe and reliable, and suitable for clinical application.

The internship is the transition period of a medico becoming a doctor,the cultivation of clinical work ability of interns is a comprehensive ability cultivation which includes the foundation theories' consolidation and use,the practical operative train- ing,the cultivation of clinical thought ability and communication between doctors and patients,etc.To educate pediatrics intern has its characteristics.

Behcet Syndrome ; complications ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications

Antibiotics, Antineoplastic ; pharmacology ; Apoptosis ; drug effects ; Breast Neoplasms ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Down-Regulation ; Doxorubicin ; pharmacology ; Female ; Humans ; Oligonucleotides, Antisense ; pharmacology ; Phosphoproteins ; metabolism ; RNA-Binding Proteins ; metabolism ; Random Allocation

Purpose To retrospectively analyze and summarize the image features of rare ovarian clear cell carcinoma (OCCC), and to provide basis for clinical diagnosis. Materials and Methods CT and MRI features of 30 cases of OCCC confirmed by pathology were retrospectively analyzed. Sixteen of all the patients underwent pre- and post-contrast CT scan. And 14 patients underwent pre- and post-contrast MRI scans. Results ① CT features: unilateral mass was revealed in 15 cases and bilateral mass was in 1 case. The maximum diameter of the mass ranged from 8 to 23.7 cm, mean (12.86±3.96) cm. One mass was irregular, 4 masses revealed incomplete capsule, and 4 masses had septa in the mass. CT value of cystic part of the mass was 20-30 HU, and which of solid part was 28-53 HU. On post-contrast CT images, the septa and solid component of the mass showed marked enhancement and delay enhancement, while the cystic component showed no enhancement. ② MRI features: Unilateral mass was revealed in 13 cases and bilateral mass was in 1 case. The maximum diameter of the mass ranged from 9.2 to 30.0 cm, mean (14.03±4.72) cm. One mass was irregular, 2 masses revealed incomplete capsule, and 2 masses had septa in the mass. The cystic component showed heterogenous signal intensity on T1WI, and high signal intensity on T2WI. There was no enhancement on post-contrast images. The solid component showed iso-intensity on T1WI, high signal intensity on T2WI, and diffused restricted on diffusion-weighted images. There was markedly enhancement on post-contrast images. ③ Blood supply of the tumor: In 8 cases, the branch of enlarged ipsilateral ovarian artery fed the tumors. In other 16 cases, the masses were surrounded by enlarged ipsilateral ovarian vein. Conclusion The characteristic CT and MRI features of OCCC include: a cystic solid mass with complete capsule; the solid component projects into the cavity, which could be hypervascular and marked enhanced.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cluster Analysis ; Diagnosis, Differential ; Female ; Humans ; Liver Diseases ; classification ; epidemiology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Yang Deficiency ; classification ; epidemiology ; Yin Deficiency ; classification ; epidemiology

OBJECTIVETo explore the effects of warm needling combined with Zhangmo decoction (see text) on endometrial receptivity in patients with clomiphene (CC)-induced ovulation.

METHODSOne hundred and sixty cases were randomly divided into a CC group (group A), a CC+ progynova group (group B), a CC+ Zhangmo decoction group (group C) and a CC+ Zhangmo decoction + warm needling group (group D), 40 cases in each one. In the Group A, CC alone was applied. In the group B, progynova was jointly used on the 8th day of menstrual cycle. In the Group C, Zhangmo decoction was jointly used on the 5th day of menstrual cycle. In the group D, based on treatment of the Zhangmo decoction, warm needling was applied at Guanyuan (CV 4), Zhongji (CV 3) and Zigong (EX-CA 1) etc. The endometrial thickness and type, pulsatility index (PI), resistance index (RI), ratio of S/D on day of human chorionic gonadotropin (HCG) and pregnancy rate were observed in fou groups.

RESULTSThe PI, RI and S/D in the group C and D were obviously lower than those in group A and B (all P < 0.01). The endometrial thickness was (7.7 +/- 1.49) mm in group B, (8.2 +/- 1.54) mm in group C and (8.9 +/- 1.51) mm in group D, which were significantly different from (6.4 5 +/- 1.26) mm in the group A (all P < 0.01) also there was a significant difference between group C and D (P < 0.05). The rate of endometrial type A was 65.0% in the group D, which was significantly higer than 27.5% in the group A, 32.5% in the group B and 35.0% in the group C (all P < 0.01). The pregnancy rate was 30.0% in the group D, which was obviously higher than 12.5% in the group A, 15.0% in the group B and 17.5% in the group C (P < 0.05). The endometrial thickness and rate of endometrial type A in the pregnant were obviously higher than those in the non-pregnant (both P < 0.01) while PI, RI and S/D was lower than those in the non-pregnant (P < 0.01, P < 0.05).

CONCLUSIONWarm needing combined with Zhangmo decoction could improve endometrial thickness, morphology and uterine spiral artery to improve pregnancy rate, which has superior effect to clomiphene, clomiphene combined with progynova and clomiphene combined with Zhangmo decoction.

Chorionic Gonadotropin ; metabolism ; Clomiphene ; administration & dosage ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; drug therapy ; metabolism ; physiopathology ; therapy ; Ovulation Induction ; Pregnancy

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Spinocerebellar Ataxias ; therapy ; Treatment Outcome ; Young Adult

Objective:To construct an adenovirus-mediated anti-sense RNA targeting K-ras exon 1 of SW1990 cell line and observe its effect on ceil proliferation and apoptosis after transferred into SW1990 cell line.Methods:K-ras exon 1 cDNA was cloned into shuttle vector pShuttle-CMV and the resultant plasmid was confirmed by enzyme digestion and PCR.Clones with inverted insertion were selected and co-transferred into E.coli BJ5183 with an adenoviral backbone plasmid pAdEasy-1 to produce recombinant plasmid by homologous recombination.Recombinants were then selected and transfected into 293 cell line to produce recombinant adenovirus.Recombinant adenovirus production was confirmed by PCR analysis and was amplified and purified;the virus titer was determined.Ad-LacZ was used to infect SW1990 cells and the infection efficiency was observed by X-gal staining.SW1990 cells was infected with the recombinant adenovirus and their proliferation and apoptosis were determined by MTT and annexin V/PI FCM assay.Results:A 282 bp target gene fragment was acquired by PCR;the titer of recombinant adenovirus was 7.6?10~8 pfu/ml before purification by CsCl_2 gradient centrifugation and 5.0?10~(10)pfu/ml after CsCl_2 gradient centrifugation.When the recombinant adenovirus was at 100 MOI,the infection efficiency of SW1990 cells nearly reached 100%.The transfection of recombinant adenovirus significantly inhibited SW1990 cell proliferation(P