Background Vitrectomy is an effective method to proliferative diabetic retinopathy (PDR) in type 2 diabetic patients.Postoperative vitreous hemorrhage is a major cause of vision loss.Objective This study was to analyze the related factors of vitreous hemorrhage after vitrectomy in proliferative retinopathy with type 2 diabetes.Methods Three hundred and five eyes of 305 cases who received vitrectomy for PDR from type 2 diabetes were retrospectively investigated.The clinical data of 14 eyes with vitreous hemorrhage after vitrectomy were analyzed.Results Vitreous hemorrhage after vitrectomy occurred in 14 eyes with the incidence 4.6％.The PDR was grade ⅣV in 3 eyes,grade Ⅴ in 4 eyes and grade Ⅵ in 7 eyes.Pars plana vitrectomy with intraocular laser photocoagulation was performed on all the 14 eyes,and 1 eye accepted scleral condensation and 8 eyes accepted silicone oil tamponade.Visual acuity was improved in 6 eyes,unchanged in 4 eyes and worsen in 4 eyes after initial surgery.Vitreous hemorrhage appeared in postoperative 1-7 days in 9 eyes,8 days-3 months in 1 eye,3-6 months in 2 eyes and over 6 months in 2 eyes.The cause for postoperative vitreous hemorrhage included residual neovascular membrane,insufficient photocoagulation range and intensity,neovascularization and instable blood glucose level.Vitreous hemorrhage disappeared in 5 eyes after medicine therapy,and reoperation in 9 eyes.In the end of the follow up,visual acuity improved in 9 eyes,unchanged in 2 eyes and worsen in 3 eyes.Retinas reattached in 13 eyes.However,the retina was still detached in 1 eye with silicone oil tamponade.Conclusions Postoperative vitreous hemorrhage usually occurs within 1 week.The main related factors are residual retinal neovascular membrane,inadequate intraocular laser photocoagulation and unstable blood glucose level.Medicine therapy is effective for postoperative vitreous hemorrhage in type 2 diabetic patients,but re-vitrectomy is needed for excessive vitreous bleeding.

The main impacting factors on implementing clinical pathway were analyzed by applying fishbone diagram.The factors include policy factors,organizational factors and personal factors.It was suggested to improve the trial work of implementing clinical pathway management by reforming the medical care payment system,putting the clinical pathway management into the evaluation system,building up medical information system,putting more efforts on promotion and enhancing cooperation among related departments.

Objective To discuss the TARP (transoral pharyngeal atlanto axioal reduction plate,TARP) stress distribution under the condition of atlantoaxial dislocation treatment with the TARP system and explore the possible suggestion for the further innovation of the TARP system.Methods A fixed Finite Element model was constructed for transoral atlantoaxial reduction plate system based on the CT digital data of the China Digital Human NO.1.The internal structure changes and the stress distribution of TARP system under different loads were imitated and analyzed.Results The results showed that,after the fixation of the TARP system,different parts of the atlantoaxial had different stress under anteflexion,extension,lateral bending and rotation,the internal fixation parts located mainly at the mid-part of the TARP(0.159 × 108 ～0.732 × 108 Pa) and the root of the screw(0.214 × 109 ～0.958 × 109 Pa).Beside that,when using anteflexion,the stress mainly focused on the articular surface of the atlantoaxial(0.512 × 107 Pa).As for extension,the stress mainly focused on the part between the lateral mass and anterior arch (0.582 × 107 Pa).While lateral bending or rotation,the stress mainly focused on the axial screw nailing path (0.287 × 109 Pa and 0.241 × 109 Pa).Conclusions Although different parts of the TARP plate have different stress,its maximum stress lied in the root of the screw.The stress of plate mainly focused on the mid - part,no matter in what state of motion,therefore,the root of the screw and the mid-part of the plate bore the biggest stress,their strength decided the fatigue property of the TARP system.

OBJECTIVE: To search the features and the treatment of vascular compressive syndrome caused by the facial, acoustic nerves. METHOD: Ten cases of vascular compressive syndrome caused by the facial, acoustic nerves were included in the group,which were treated by microvascular decompression(MVD). Besides, the microanatomic relationship between the nerve and their adjacent vessel at the root exit zone (REZ) were observed under microscope or nasoendoscopy in MVD. RESULT: Tinnitus, vertigo and facial spasm disappeared after MVD in 7 cases (70%), improved in 2 cases (20%), and relapse in 1 case (10%). All cases were found out vessels compressing at the root zone of the facial nerve and the auditory nerve. CONCLUSION The Clinical features of vascular compressive syndrome caused by the facial, acoustic nerves are facial spasm, tinnitus, and vertigo, for which microvascular decompression has a positive therapeutic effect as long as the diagnosis is correct.
Adult ; Cochlear Nerve ; Decompression, Surgical ; Facial Nerve ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; physiopathology ; surgery

Objective To elucidate the mutations of NPHS1 gene in children with sporadic steroid-resistant nephrotic syndrome (SRNS) in Southern Chinese Han ethnic group.Methods Peripheral blood samples were collected for genetic analysis from 40 patients with sporadic SRNS and 50 healthy volunteers as control.Genomic DNA was isolated from peripheral blood leucocytes.Twenty-nine exons and exon-intron boundaries of the NPHS1 gene were amplified by polymerase chain reaction.Mutational analysis was performed by DNA sequencing directly.Results Seven variants,928G＞A(D310N),2677A＞G (T893A),2869G＞C (V957L),IVS8+30C＞T,IVS21+14G＞A,IVS25-23C＞T and *142T＞C,of NPHS1 gene were found in 6 of 40 children with sporadic SRNS,whereas they were not found in 50 healthy controls.2677A ＞G,IVS8 +30C ＞T,IVS21 +14G＞A,IVS25-23C ＞T and *142T＞C were novel.Moreover,thirteen already reported NPHS1 polymorphisms,294C＞T,349G＞A,IVS3+15C＞T,IVS3+61A＞G,803G＞A,IVS8+68A＞G,1339G ＞A,1802G ＞C,2223C ＞T,2289C ＞T,IVS24 +36C ＞T,3315G＞A and IVS27 +45C ＞T,were detected in some patients and controls. Conclusions NPHS1 mutations in 6 of 40 children with sporadic SRNS in Southern Chinese Han ethnic group (15％) are detected.NPHS1 mutations are existed in Southern Chinese children,so it is necessary to perform the mutation analysis of NPHS1 gene in those children patients.

BACKGROUND: Experiments have demonstrated that autologous vascular endothelial cells if transplanted onto artificial vascular cavosurface, can enhance the patency rate of vasotransplantation. Whether seeding of prostheses interposition grafts with bone marrow-derived endothelial cells is effective for in vivo endothelialization of artificial vessels remains unclear.OBJECTIVE: To observe the effect of endothelialization of vascular prosthesis by seeding prostheses interposition grafts with bone marrow-derived endothelial cells in animals.DESIGN: A controlled animal experimental study.SETTING: Shanghai Sixth People's Hospital.MATERIALS: This study was carried out in the Shanghai Sixth People's Hospital between September 2000 and October 2001. Twenty hybrid dogs from Shanghai, of either gender, aged 1.0 to 2.0 years old, weighing (18.7±2.3) kg, were involved in this study.METHODS: Bone marrow-derived mononuclear cells were isolated from the dogs. The endothelialization of ePTFE prostheses interposition grafts (4 mm×4 cm and 8 mm×5 cm)was carried out. Common carotid artery transplantation:Ten laboratory dogs were involved. Common carotid artery of 4 cm was resected from each dog. ePTFE prostheses interposition grafts of 4 mm×4 cm was transplanted into the bilateral common carotid artery, and prostheses interposition grafts were performed endothelialization, namely experimental group. Those prostheses interposition grafts, which were not performed endothelialization, were named as control group. Five dogs were used in each group. Patency rate and blood flow rate of transplanted vessels were detected with a color ultrasonograph 2 weeks and 2 months after operation.Inferior caval vein transplantation: Six of the rest 10 dogs were used for experiments. Under the anesthesia, 8-10 cm inferior caval vein was dissociated from each dog. Its two ends were blocked, and about 5 cm inferior caval vein was resected. ePTFE endothelialized vascular prosthesis with 8 mm in diameter and 5 cm in length was anastomosed end to end with 5-0 Prolene. The other 4 dogs were used for control experiment. ePTFE vascular prosthesis with the same specification was used as prostheses interposition graft. Vascular patency rate was determined 2 months after operation.At the same time, coverage rate and intimal thickness of transplanted vascular endothelial cells and vascular intimal thickness were determined.MAIN OUTCOME MEASURES: ①The patency rate and blood flow rate of transplanted vessels at different time points. ②Coverage rate of transplanted vascular endothelial cells and vascular intimal thickness.RESULTS:① At 2 weeks and 2 months after common carotid artery transplantation, the patency rate of experimentalside was 100%(5/5)and 60%(3/5), respectively, and that of control side was 40%(2/5)and 0%(0/5), respectively. At postoperative 2 months, the mean blood flow rate in the experimental group was obviously smaller than that in the control group (P ＜ 0.05). At 2 months after inferior caval vein transplantation, the patency rate of experimental group and control group was 83%(5/6)and 50%(2/4), respectively. ②At 2 weeks after common carotid artery transplantation and inferior caval vein transplantation, the coverage rate of vascular endothelial cells in the experimental group was significantly larger than that in the control group, separately (P ＜ 0.05). At 2 months after each transplantation, the vascular intimal thickness in the experimental group was significantly smaller than that in the control group (P ＜ 0.05).CONCLUSION: Seeding of ePTFE prostheses interposition grafts with bone marrow-derived endothelial cells can rapidly accomplish in vivo endothelialization and inhibit intimal hyperplasy; Circulating endothelial cells, as the potential source of endothelial cells, have certain clinical application values.

BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to establish cellular membrane and extract mitochondria. Furthermore, fluorescence polarization of cellular membrane (reflecting liquidity in cellular membrane lipid area), malondialdehyde (MDA) content of mitochondria, superoxide dismutase (SOD) activity and respiratory controlling rate were measured; meanwhile, mitochondrial ultrastructure of skeletal muscle was observed under transmission electron microscope.MAIN OUTCOME MEASURES:①Fluorescence polarization of cellular membrane, MDA content of mitochondria, SOD activity and respiratory controlling rate of skeletal muscle; ②mitochondrial ultrastructure of skeletal muscle.RESULTS: All 36 rats were involved in the final analysis without any loss. ①SOD activity and respiratory controlling rate of mitochondria in skeletal muscle: The values of these two items were higher in edaravone group that those in cryopreservation group (P＜0.05).②Fluorescence polarization of cellular membrane and MDA content of mitochondria in skeletal muscle: The values of these two items were lower in edaravone group than those in cryopreservation group (P＜0.05). ③Mitochondrial ultrastructure of skeletal muscle: Injured degree of skeletal muscle was milder in edaravone group than that in cryopreservation group.CONCLUSION: Edaravone can relieve ischemia/reperfusion injury of skeletal muscle and protect cellular membrane and mitochondria of skeletal muscle. Its mechanism may be related to directly inhibiting hydroxy free radicals, increasing SOD activity of skeletal muscle, reducing generation of MDA and promoting normal oxidative phosphorylation.

BACKGROUND:The main component of cartilage, type Ⅱ col agen gene expression in chondrocyte is positively correlated with SOX9 concentration in a dose-dependent manner.
OBJECTIVE:To observe the variation of SOX9 and type Ⅱ col agen mRNA content at different periods in the differentiation process (osteogenic, chondrogenic, adipogenic induction) of mesenchymal stem cel s, and to explore the correlation of SOX9 expression and type Ⅱ col agen.
METHODS:Bone marrow mesenchymal stem cel s were isolated from 4-week-old Kunming mice, and cultured in vitro to passage 3. The cel phenotype was identified with flow cytometry. Cel s were divided into three groups and subjected to three kinds of induction conditions favorable for adipogenic, chondrogenic and osteogenic differentiation, and each group was observed at three time points. In addition, the non-induced cel s were used as a control group. The total RNA of cel s was extracted at 3, 7, 14 days after induction, and SOX9 and type Ⅱ col agen mRNA was quantified with reverse transcription-polymerase chain reaction. The induced cel s were stained by immunofluorescence to observe the differentiation and perform statistical analysis.
RESULTS AND CONCLUSION:Passage 3 bone marrow mesenchymal stem cel s grew wel , and cel phenotype was confirmed as stem cel s by flow cytometry. The staining results showed that, the cel s differentiated into chondrocytes, adipocytes and osteoblasts. The SOX9 mRNA levels in the induced cel s were the highest in chondrogenic differentiation group, then in osteogenic differentiation group, and the lowest in adipogenic differentiation group. Type Ⅱ col agen mRNA levels in the induced cel s were the highest in chondrogenic differentiation group, then in adipogenic differentiation group, and the lowest in osteogenic differentiation group. SOX9 expression in chondrogenic differentiation group increased at 3 and 7 days, and then decreased at 14 days. While type Ⅱ col agen expression increased at 3, 7, 14 days. SOX9 mRNA levels increased as the osteogenic differentiation, while type Ⅱ col agen expression gradual y decreased. There was no significant difference in the SOX9 mRNA expression between adipogenic differentiation group and control group (P>0.05), while type Ⅱ col agen expression was not regularly changed. Experimental findings suggest that, critical effect of SOX9 in chondrogenic differentiation is better than that in osteogenic and adipogenic differentiation. SOX9 is associated with type Ⅱcol agen, which may alter along with the SOX9 in the early chondrogenic differentiation;SOX9 may play a fine-tuning role in the process of chondrogenic and osteogenic differentiation.

Objective To investigate the safety,feasibility and effectiveness of early oral feeding after colorectal surgery. Methods A randomized controlled trial enrolled 47 patients undergoing elective open colorectal surgery from May 2007 to November 2007. The patients were randomized into group of early oral feeding (experimental group) or group of traditional oral feeding(control group). Postoperative course, gastrointestinal function, and complications were evaluated. Results No statistically significant differences were found in clinical characteristics including age, types of procedures, times of surgery or comorbidity between the two groups. There was no perioperative mortality in the two groups. Stoma1 leak occurred and progressed to abdominal abscess in one case in the control group. Passage of flatus and defecation after operation was earlier in experimental group than in control group(1.9 ± 0. 6 d vs. 2. 8 ± 0. 9 d,P <0. 01). Length of postoperative intravenous infusion was shorter in the experimental group (3. 8 ± 0. 9 d vs. 4. 8 ± 1.2 d,P < 0. 01). Length of postoperative stay was also shorter (9.0 ± 3.2 d vs. 10. 0 ± 3. 3 d, P = 0. 27) and the rate of abdominal distension was lower in experimental group(27% vs. 44%, P = 0. 23). The rate of nausea and vomiting was higher in the experimental group(31% vs. 20% ,P =0. 35), the differences were of no significance. Reinsertion of nasogastric tube due to nausea and vomiting and reoperation was necessary in 2 patients in the experimental group and control group respectively. There were 3 patients complaining fever postoperatively in the control group. Conclusions Early oral feeding after colorectal surgery is safe and feasible, and it can promote postoperative recovery effectively.

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.