Diabetic retinopathy ( DR ) is one of the most serious microvascular complications of diabetes. It also is a world's major causes of blind eye diseases. Although the injection of anti - vascular endothelial growth factor intraocular drug is becoming a hotspot of current research. Pan retinal photocoagulation (PRP) remains the effective and economical treatment for DR. As a destructive treatment, PRP will inevitably cause some changes on the normal morphology and function of the retinal and cornea. Currently, with the development of the optical coherence tomography, confocal microscopy and other auxiliary examination, we have more accurate and objective research to better understand the laser-neural tissue interaction. This may help us to protect the patient's visual function more efficiently.

Objective To study the therapeutic effect of catgut net wrapping for preservation of the injured spleen.Methods Catgut net wrapping method was used to preserve the injured spleen,and the clinical material of those patients treated by the wrapping method was retrospectively evaluated.Results Ultimate spleen recovery was achieved in each case of 15 patients without postoperative bleeding observed,any abscess formation,or complications related to the use of catgut net wrapping.The patients were discharged after 10 to 14 hospital dayS.Two-week-fol-low-up results showed this therapeutic opinion is safe.Conclusion As a means of preserving the injured spleen,the catgut net wrapping method was simple,safe,and efficacious.

Objective To estimate the operational efficiency of 37 county level public general hospitals in Hubei province using the world popular method of Bootstrap-data envelopment analysis.The aim is to make up for the theory and methodology gaps on DEA research for hospitals in China,and to provide policy and management recommendations for their further improvement.Methods The input and output indicators of hospital efficiency evaluation were selected based on our previous research.R Software was used to describe the current input and output indicators,while FEAR package used to measure Bootstrap-DEA efficiency value of the sample hospitals with bias corrected,along with such applied analysis as efficiency benchmarking for the technical efficiency outcomes.Results There are great differences among the healthcare input and output of these hospitals.In particular,the difference in the number of actual beds was 4.67 times between the highest hospital and the lowest one.All of the bias corrected efficiency scores were lower than those before correction,and the average bias corrected score of the sample hospitals is 0.717 9.Moreover,only 20 hospitals(54.05%)have their efficiency scores above the median level.Conclusions The healthcare resources allocation of these hospitals needs to be further optimized.Hospitals still have big potential to improve their efficiency.Besides providing policy support,the government is advised to guide hospitals to innovate their management mechanisms,such as introducing and applying benchmarking,ranking,inter-hospital learning among others,so as to continuously improve their operational efficiency.

ObjectiveTo evaluate the diagnostic performance of bone SPECT and CT fusion imaging in bone metastases from pediatric neuroblastoma.MethodsTwenty-four pediatric patients with neuroblastoma were included in this retrospective study.All patients underwent planar imaging and SPECT integrated with CT.Lesion visibility,diagnostic certainty and diagnostic performance were evaluated with KolmogorovSmirnov test andx2 test.ResultsLesion visibility of SPECT alone,SPECT integrated with CT were significantly better than that of planar imaging ( both H =69.000,P ＜ 0.05 ).SPECT and CT fusion imaging,SPECT alone both detected five more bone lesions than planar bone imaging (77 vs 72).The diagnostic accuracy of SPECT imaging (62.34％,48/77 )was significantly higher than that of planar imaging (45.45％,35/77; x2 =4.416,P ＜ 0.05 ).The sensitivity,specificity and accuracy of SPECT and CT fusion imaging for diagnosing malignant bone lesions were significantly higher than those of planar imaging:82.35％ (42/51) vs 53.19％ ( 25/47),88.46％ ( 23/26 ) vs 40.00％ ( 10/25 ),84.42％ ( 65/77 ) vs 45.45％ (35/77 ; x2 =12.571,14.016,25.667,all P ＜ 0.01 ).The diagnostic specificity and accuracy of SPECT and CT fusion imaging were significantly higher than those of SPECT alone ( 53.85％,14/26 ;62.34％,48/77) (x2 =7.589,9.606,both P ＜0.01 ).However,there was no significant difference of sensitivity between the two methods (x2 =2.942,P ＞ 0.05 ).Diagnostic certainty by SPECT and CT fusion imaging was significantly higher than that by SPECT alone ( H =28.000,P ＜ 0.05 ) and by planar imaging (H =21.000,P ＜ 0.05).ConclusionSPECT and CT fusion imaging can detect more bone lesions in patients with pediatric neuroblastoma.It is helpful for diagnosing bone metastases from pediatric neuroblastoma.

Objective To evaluate the curative efficacy of endoscopic retrograde cholangiopancreatography (ERCP) on bile leaks after orthotopic liver transplantation (OLT). Methods Data of 12 cases, hospitalized in our hospital from March 2013 to February 2016, with bile leaks after OLT confirmed by magnetic resonance imaging of the pancreas (MRCP) or ERCP were retrospectively analyzed . The curative efficacy of ERCP was evaluated including clinical symptoms of bile leaks and complications, occurrence time and location, diagnosis and treatment process and efficacy. Results In this study, 12 cases were male patients, with the average age of 49.75 ± 8.55 (age from 35 to 62 years old). Among them 11 cases were successfully treated by endoscopic nasobiliary drainage (ENBD), and the success rate of endoscopical therapy was 91.7%, the curative rate of bile leaks was 91.7%(11/12). No ERCP related serious complications and death were found in patients. Nine cases combined with biliary strictures and/or biliary duct stone/bile plug were performed endoscopic sphinctrotomy (EST) during the first time of ERCP, and accepted further ERCP treatment after 2 weeks when the bile leaks were healed. All patients with ENBD were carried out well except one case. Conclusion ERCP is a safe and effective minimally invasive treatment method for different types of bile leaks after OLT.

Objective To study the inhibitory effects of dendritic cells modified by sCD41)gene on T lymphocytes phenotypes and cytokines production and the mechanism of inducing donor-specific immune tolerance in vitro.Methods T lymphocytes prepared with Nylon Fiber Column from Balb/c mice(as reaction cells)and DCs of different groups(as stimulation cells)were subjected to primary mixed lymphocyte culture(MLC).After incubation for 7 days,the responsiveness of the cells was de- tected by MTS method at the indicated time points,and supernatants were assayed for IFN-?,IL-2, IL-4,IL-10 by ELISA kits.On the day 5,the cultured cells were assessed for the expression of CD4, CDS,CD25 and CD69 by using flow cytometry(FCM).After secondary MLC for 5 days,the same indexes were assayed hy using the same methods.Results Dendritic cells modified by sCD40 could in- duce the hyporesponsiveness to alloantigen in primary and secondary MLC.In primary MLC,the ex- pression of CD4~+ and CD8~+ T cells and CD4~+ CD25~+,CD8~+ CD25~+,CD4~+ CD69~+,CD8~+ CD69~+ T cells in IX;modified by sCD40 group were less than those in control group(P

Objective To investigate the effects of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)on acute myocardial functional lesion after severe craniocerebral injury.Methods Sixty five examples with severe craniocerebral injury are collected in the 253th hospital of PLA from February in 2009 to May in 2012,of whom glasgow coma scale was low or equal to 8 points.They are examined creatine kinase-MB(CK-MB),cardiac troponin T(cTnT),TNF-αand IL-6 for correlative analysis while they are emer-gency treated at the same time.Results The myocardial function of the observe group examined results:CK-MB(198.63±37.72) U/L,cTnT(548.17±49.58)pg/mL;injury factors examined results:TNF-α(39.93± 18.88)ng/mL,IL-6(469.61 ±73.66)ng/mL.It both has evidently difference between the control group and the observe group and has obviously correlation between the my-ocardial function and injury factors of the observe group (P <0.01),and they were positively correlated.Compared TNF-α,IL-6 in observe group,CK-MB(r>0.911 4)and cTnT(r>0.942 1)had statistically significant difference.Conclusion TNF-αand IL-6 all participate in the process of the acute myocardial functional lesion after severe craniocerebral injury.The inchoate interference and treatment against TNF-αand IL-6 are possible to have inhibited the high expression of TNF-αand IL-6 in the blood and to improve the myocardial functional lesion after severe craniocerebral injury.

Objective To investigate the value of the manipulative reduction monitored by ultrasound for the intussusception of children.Methods One hundred and three intussusception children were dynamically observed by ultrasound,and were pressed softly beginning with the head of the intussusceptum,and observed whether there was intestinal peristalsis, and whether the intussuseeptum shortened and disappeared finally.The results were analyzed based on the size of the masse, the length of the intussusceptum,and the patients' age,and compared with the X-ray high pressure air enema.Results Fifty (48.5 ％) intussusception children were recovered.The recoverability was related to the size of the mass, the length of the intussusceptum, and the age of the children (level of cooperation).Thirty-nine patients were recovered after reexamined one hour later.The recoverability of manipulative reduction monitored by ultrasound for the mass diameter less than 2.0 cm was obviously higher than that by X-ray high pressure air enema.Conclusions Manipulative reduction monitored by ultrasound could cure almost half of the intussusception children patients directly.It could decrease the number of patients who were treated with high-pressure air enema,it could relieve the pain of the children and reduce their medical expenses.It also could be acted as a screening way to other therapies like high pressure air enema.

Objective To evaluate the assistant diagnostic value of low dose CT in patients with pulmonary embolism (PE) based on ventilation/perfusion (V/Q) SPECT imaging.Methods One hundred and two patients with clinical suspected PE had been enrolled for this retrospective study.The final diagnosis of PE was made according to the 2008 guidelines of European Society of Cardiology (ESC).All patients underwent V/Q SPECT/CT (Hawkeye 4,GE).The imaging findings from low dose CT lung window were used for differential diagnoses of abnormal regions in SPECT imaging.The diagnostic efficiency of V/Q SPECT alone was compared with that of V/Q SPECT combined with low dose CT scan.Crosstabsx2 test was performed using SPSS 13.0 software.Results Twenty-nine patients (28.43％,29/102) were finally diagnosed as PE.V/Q SPECT alone had a sensitivity of 93.10％ (27/29),a specificity of 90.41％ (66/73),and an accuracy of 91.18％ (93/102).With additional diagnostic information from low dose CT,the diagnostic specificity increased to 95.89％ (70/73,X2 =1.72,P ＞ 0.05 ),and the accuracy increased to 95.10％ (97/102,x2 =1.23,P ＞ 0.05) though the sensitivity remained the same.Conclusion Imaginginformation from low dose CT in hybrid SPECT/CT may enhance V/Q diagnostic accuracy for PE.