Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease,and the pathogenesis of TAO is still unclear at present,so it is difficult to take proper prevention and treatment.TAO is a polygenic disease,it is a result of both genetic and environmental factors.Now a large number of researchers showed genetic predisposition of TAO,such as associated genes about cytokine (CK),human leukocyte antigen DR gene (HLA-DR),uridine diphosphate glucose phosphate dehydrogenase gene (UGDH),parathyroid hormone-like hormone gene (PTHLH),human beta defensin-2 gene (HBD-2),cytotoxic T lymphocyte associated antigen-4 gene (CTLA4),cluster of defferentiation 86 gene (CD86) and CD103 gene,cardiac calsequestrin-2 gene (CASQ-2),Toll-like receptor-9 gene (TLR-9),peroxisome proliferation factor receptorγ activation gene (PPAR-γ2),hyaluronan synthase gene (HAS),hyaluronidase gene (HYAL),etc.This review summarizes the corresponding associations respectively based on specific genetic research,so as to have a system understanding to TAO susceptibility genes.

Objective To explore the early diagnosis and treatment of bronchopulmonary dysplasia (BPD) in premature. Methods Observing and analyzing the onset ,diagnosis of BPD and the outcome treated by dexamethasone in 12 cases that were hospitalized in NICU during the period from January 1994 to January 1999.The follow up study was done for 6 to 12 months after their discharge. Results All of these 12 infants treated by dexamethasone were cured and discharged. The time period of hospitalization was 31 to 67(50?14) days. The one year follow up study after discharge showed that the prognosis of 11 patients were good, only 1 infant suffered from repeated respiratory tract infection. Conclusion Careful observation on clinical manifestations and lab work should be done to those premature babies who suffered from BPD easily for early diagnosis. The early application of dexamethasone in infants with BPD showed perfect results.

Objective To study the significance of cytokine tumor necrosis factor ? (TNF ?) gene promoter 308 position polymorphisms in predicting acute graft rejection following renal transplantation. Methods In 35 preoperative recipients,TNF ? produced by peripheral blood cells was measured by enzyme linked immmunosorbent assay,and their TNF ? gene promoter 308 position polymorphisms were determined by PCR restriction fragment length polymorphisms(PCR RFLP).The association between TNF ? gene promoter polymorphisms and production of them was studied.Furthermore,the correlation between their polymorphisms and acute rejection in the first 3 months after renal transplantation was discussed. Results The recipients with A/A or A/G genotype in TNF ? promoter 308 position secreted more cytokine (624.96?177.78)pg/ml and (544.32?132.42)pg/ml than those with G/G (233.16?25.37)pg/ml, P

AIM: To investigate the efficacy of N-acetylcysteine (NAC) and taurine (Tau) in preventing hyperoxia-induced the lens opacification and the changes of biochemical parameters on organ cultured rabbit lenses.METHODS: Twenty-four lenses from adult rabbits were divided into the control group, the hyperoxia-exposed group, the hyperoxia-exposed group containing 20mmol/L of NAC, the hyperoxia-exposed group containing 80mmol/L of Tau, respectively. The treated groups incubated with hyperoxia ( pO2>80%) for 4 hours per day throughout a 7-day period. Lens transparency, histology and enzymatic activities measurements were determined after this incubation.RESULTS: Gross morphological examination of these lenses revealed some severe cortical opacification in the hyperoxia-exposed group, moderate cortical opacification in the control group and the Tau treated group. There was minimal cortical opacification in the NAC treated group. The glutathione (GSH) content and the activity of Na, K-ATPase were significantly decreased in the hyperoxia-exposed group than that of the control group, by 37.8% (P<0.05) and 53.5% (P<0.05), respectively. However, they were increased in the two treated groups, especially in the NAC treated group. There were no significant differences in the water-soluble protein content and the catalase and GSH reductase activities in all group lenses.CONCLUSION: Hyperoxia can induce the cortical opaci-fication in the lens. The role of NAC in the prevention of hyperoxia-induced cataract is superior to Tau.

AlM:To investigate the effect of teaching mode of problem- based learning ( PBL ) in the teaching of medical students' clinical ophthalmology.
METHODS: Five classes ( total 148 students ) were randomly selected as experimental group, using PBL method, at the same time another 5 classes ( total 151 students) were also randomly selected as control group, using lecture-based learning ( LBL) mode in 2010 grade. The scores of the experimental group were compared with control at the end of term. ln addition, students and teachers were respectively interviewed using self -administered questionnaire to obtain their evaluation for PBL practice.
RESULTS:The mean scores of PBL group (78. 35±7. 63) were significantly higher than control group (71. 68±6. 37) (P<0. 001). Most of students thought that their ability of referring, synthesizing and analyzing information was enhanced by PBL, and their skills both in written and oral were also improved. PBL made it easier to understand the contexts of course. lt was the best way to improve the effect of teaching in ophthalmology based on the increase of quality in novitiate that gives more chance to students of contacting with practice, developing the ability of clinical thinking and verifying the theory in clinical novitiate. Lots of teachers considered that the classroom atmosphere was more active, students were becoming more and more proactive on their classes and the relationship between students and teachers were more harmonious when PBL was used.
CONCLUSlON:Using PBL teaching mode can highly improve the teaching effectiveness of clinical epidemiology, which is worth popularizing.

Diabetic retinopathy is a major cause of blindness all over the world, and it is one of the most serious and common microvascular complications of diabetes. Breakdown of the endothelial blood - retinal barrier ( BRB ) , as occurs in diabetic retinopathy, result in vasogenic edema and neural tissue damage, causing loss of vision. The inner BRB is created by complex tight juctions of retinal capillary endothelial cells, this barrier prevents the free diffusion of substances between the circulating blood and the neural retinal, the inner BRB efficiently supplies nutrients to the retinal and removes endobiotics and xenobiotics from the retina to maintain a constant milieu in the neural retina. The central mechanism of altered inner BRB function is a change in the permeability characteristics of retinal endothelial cells caused by elevated levels of cytokines, growth factors, advanced glycation end products, inflammation, hyperglycema and loss of pericytes. This article reviews the relationship between diabetes and the ultrastructure changes of BRB.

Objective To investigate the change of indications of emergency obstetric hysterectomy and the clinical application of intraoperative interventions. And to provide evidence for prevention of hysterectomy and improvement of obstetric quality. Methods Clinical data were collected from 97 patients who received emergency obstetric hysterectomy at Shengjing Hospital of China Medical University between January 1st, 2004 and December 31st, 2013. The patients were divided into two groups by the time point of January 1st, 2009: the first group was cases treated between January 1st, 2004 and December 31st, 2008, while the second group was cases treated between January 1st, 2009 and December 31st, 2013. The clinical indicators, surgical indications, intraoperative interventions, and blood loss between the two groups were analyzed retrospectively. Results (1) Incidence:54 857 women delivered at Shengjing Hospital of China Medical University between January 1st, 2004 and December 31st, 2013. Of them, 97 patients received emergency obstetric hysterectomy, with an incidence of 0.177% (97/54 857). (2) The 17 patients delivered vaginally (18%,17/97) and 80 by caesarean section (83%,80/97). Forty-nine patients experienced repregnancy with scar uterus (51%, 49/97). About 41 patients underwent abdominal total hysterectomy (42%,41/97) and 56 received subtotal hysterectomy (58%,56/97). (3) The number of patients were comparable between the two groups (50 vs 47;P>0.05). (4) The main surgical indication was uterine inertia (45%, 44/97). The main causes of uterine inertia were excessive uterine tension (45%, 20/44) and placental abruption due to gestational hypertension (32%, 14/44). Of all the indications, 29 patients in the first group (58%, 29/50) and 15 patients in the second group (32%, 15/47) suffered from postpartum hemorrhage. Pathological placenta embedment occurred in 15 patients in the first group (30%, 15/50) and 25 patients in the second group (53%, 25/47). The incidences of postpartum hemorrhage due to uterine inertia or pathological placenta embedment were significantly different between the two groups (both P<0.05), respectively. (5) In the first group, the average preoperative blood loss was (2 900±1 900) ml, and the average intraoperative amount of infused white&red blood cells was (5.9±3.5) U, with the average operation time of (2.2 ± 1.8) hours and the average in-hospital duration of (7.8 ± 2.3) days. In the second group, the average preoperative blood loss was (3 100± 2 200) ml, and the intraoperative amount of infused white&red blood cells was (6.2± 5.2) U, with the average operation time of (2.5± 2.1) hours and the average in-hospital duration of (7.9 ± 2.9) days. There was no significant difference between the two groups in any of these indicators (P>0.05). Postpartum hemorrhage was usually treated with uterine packing in the first group, but was preferentially treated with potent uterine contraction agents, arterial ligation, uterine balloon compression or B-Lynch suture in the second group. The therapeutic effects of these new treatments were significantly better than uterine packing (P<0.05). Conclusions The incidence of emergency obstetric hysterectomy did not change significantly in the past decade. However, the indications and intraoperative interventions have changed significantly in the second five years compared with the first five years. The main surgical indications were uterine inertia and postpartum hemorrhage due to pathological placenta embedment. Therefore, strict control of caesarean section indications was important to reduce emergency obstetric hysterectomy.

Objective To explore the effect of perioperative continuous use of aspirin on bleeding in laparoscopic anterior resection for rectal cancer (RC) in patients taking low dose aspirin.Methods The prospective study was conducted.The clinicopathological data of 96 RC patients taking low dose aspirin who were admitted to the Shengjing Hospital of China Medical University from September 2014 to September 2016 were collected.All the 96 patients were divided into the aspirin group (perioperative continuous use of aspirin) and non-aspirin group (discontinuation of aspirin at 7 days preoperatively and taking aspirin at 3 days postoperatively)by random number table.Laparoscopic anterior resection for RC was applied to patients by the same team of doctors.Observation indicators:(1) comparison of surgical and postoperative situations between the 2 groups;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative survival of patients up to January 2017.Measurement data with normal distribution were represented as (x)±s.Comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Comparison of ordinal data was analyzed using the nonparametric test.Results All the 96 patients were enrolled into the study,including 50 in the aspirin group and 46 in the non-aspirin group.(1) Comparison of surgical and postoperative situations between the 2 groups:96patients underwent successful laparoscopic anterior resection for RC,including 1 with conversion to open surgery and 95 undergoing laparoscopic anterior resection for RC,without perioperative death,postoperative blood transfusion and rcoperation.Cases with conversion to open surgery,operation time,volume of intraoperative blood loss,decreasing value of postoperative hemoglobin (Hb),time to anal exsufflation,peritoneal drainage volume from 1-3 days postoperatively,cases with postoperative hematoehezia,cardio-cerebrovascular complications and overall complications (including postoperative hematochezia and cardio-cerebrovascular complications),duration of hospital stay,hospital expenses,cases in stage Ⅰ,Ⅱ and Ⅲ of postoperative TNM stage,postoperative coagulation indexes of platelet,prothrombin time,international normalized ratio,prothrombin activity,activated partial thromboplastin time,thrombin time and fibrinogen were 0,(112± 18) minutes,(39± 18) mL,(4.3±2.8)g/L,(57±24)hours,(22±9)mL/d,6,0,10,(8.6±2.5)days,(6 739±481)yuan,11,35,4,(236±80) × 109/L,(12.7± 1.1) seconds,1.00±0.08,101％ ± 15％,(28 ±4) seconds,(15.5 ± 1.9) seconds,(3.2±1.0)g/L in the aspirin group and 1,(118±16)minutes,(38±22)mL,(3.5±3.0)g/L,(55±29)hours,(20±8)mL/d,4,1,8,(9.1±2.3)days,(6606±510)yuan,5,36,5,(211±49)×109/L,(12.5±0.7)seconds,1.00±0.06,103％±11％,(29±3)seconds,(15.3±1.7)seconds,(3.1±0.7)g/L in the non-aspirin group,respectively,with no statistically significant difference between the 2 groups (t =-1.737,0.204,1.416,0.380,1.365,x2=0.038,0.107,t=-1.082,1.322,Z=-1.370,t=1.850,0.978,0.872,-0.712,-1.291,0.311,0.585,P＞0.05).Ten patients with postoperative hematochezia in the 2 groups were cured,without special treatment.One patient in the non-aspirin group was complicated with deep venous thrombosis and then was cured by single anticoagulant drug.Two and 2 patients in the aspirin group were respectively complicated with urinary retention and urinary tract infection.One,1 and 1 patients in the non-aspirin group were respectively complicated with inflammatory intestinal obstruction,urinary retention and urinary tract infection,and then were cured by conservative treatment.(2) Follow-up situations:of 96 patients,95 were followed-up for 4-27 months,with a median time of 13 months.During the follow-up,3 patients died and 92 had survival.Conclusion The perioperative continuous use of aspirin cannot increase risk of bleeding in laparoscopic anterior resection for RC in patients taking low dose aspirin.

Objective To investigate the clinical effects of transurenthral resection of muscleinvasive bladder tumor (TURBT) in senile. Methods This study was clinical prospective random research.46 senile cases with muscle-invasive bladder cancer treated by TURBT was divided into 2 groups:control group and observed group.The observed group was treated with TURBT combined with intravesical instillation of pirarubi 30 mg immediately after TURBT,the bladder wall around tumor was resected thoroughly.The control group underwent radical cystectomy and pelvic lymph node dissection. Results The clinical improvement rate was higher in observed group than control group (85.7％ s.63.6％,X2 =5.3008,P=0.021).There was not difference in 3 years recurrence rate between observed group(25.0％) and control group(13.6％) (x2 =S.3008,P＞0.05).The 1 year survival rate were 95.8％,90.9％ and 3 years survival rate were 79.2％,72.7％ in observed group and control group,respectively,and there were no differences between the two groups(X2 =0.262,P=0.609). Conclusions TURBT combined with intravesical instillation of pirarubi can enhance clinical effect and reduce recurrence rate in the treatment of the elderly with muscle-invasive bladder cancer.

Objective To explore the influence of injury severity on transplantation of embryonic neural stem cells (NSCs) after traumatic brain injury (TBI).Methods The NSCs were isolated from the hippocampus of fetal rats aged at from 12-14 days.The cells were cultured and proliferated in the serum-free medium and identified in vitro.The animals received transplants in the bilateral hippocampal areas at day 3 following mild or moderate TBI separately.Conventional histology,TUNEL and immunohistology were examined to detect BrdU,NSE,GFAP,GalC,NGF and BDNF at day 14 post-implantation.Results BrdU-labeled positive cells in the bilateral hippocampus in the mild TBI group were more than those in the moderate TBI group at day 14 post-implantation.Significant differentiation of the astrocytes recognized as GFAP positive cells in the bilateral hippocampus was found at day 14 post-implantation.The expression of NGF and BDNF proteins was increased following TBI,the most evident in the mild TBI group.Conclusion The influence of injury severity on transplantation may be associated with the change of the microenvironment after TBI.