Diabetic retinopathy ( DR ) due to disturbance of carbohydrate metabolism is the most serious ocular complication in patients with diabetic disease, and diabetic macular edema ( DME) is one of the main causes of vision loss. lt is considered that many factors are involved in DME pathological process. DME is defined as an abnormal thickening of the macular associated with the accumulation of excess fluid in the extracellular space of the neurosensory retina. Nowadays, the main treatment methods of DME include pharmacotherapy, laser photocoagulation and surgery. lnflammatory components within the vascular tissue play an important role in the development of DME, so drug therapy is an important method for DME. ln this review, we summarized the risk factors and the current pharmacotherapy situation of DME.

[Objective]To study the pathogenesis of lumbar degenerative spondylolisthesis(LDS)through the degeneration degree of lumbar facet joints and the changes of the joint sagittal angle of little zygapophysial joints and the endplate hypozygal angle in patients with LDS and lumbar disc herniation (LDH).[Methods]The image data of 79 patients with lumbar degenerative diseases were collected from October 2009 to November 2011.There were 42 patients with L4-5 LDS(experimental group)and 37 patients in same age with L4-5 LDH(control group).The L4-5 facet joints were graded by Weishaupt ect.lumbar facet joint osteoarthritis imaging grading method.The joint sagittal angle of L4-5 little zygapophysial joints and the L4endplate hypozygal angle were detected by CT.The L4-5 facet joint osteoarthritis grading,joint sagittal angle of lumbar little zygapophysial joints,L4 endplate hypozygal angle and bilateral symmetry between two groups were compared.[Results]There was no grade 0 of facet joint osteoarthritis in both two groups.The numbers of grade 1,2,3 in experimental group were 4,20,18 cases,respectively,while the numbers in control group were 21,14,2 cases.There was significant difference between the numbers of two groups(P ＜ 0.05).The joint sagittal angle of L4-5 little zygapophysial joint,deviation angle of sagittal angle asymmetry and L endphtehypozygal angle in experimental group(26.62°± 1.67°,8.79°± 4.28°,116.92±6.86°)had statistical significance compared with those in control group(45.07° ± 7.32°,5.14° ± 4.28°,104.95° ± 4.97°)(P ＜0.01).The deviation angle of endplate hypozygal angle asymmetry in experimental group had no statistical significance compared with that in control group(P ＞ 0.05).[Conclusions] The sagittal orientation of lumbar facet joint angle and the endplate hypozygal angle increasing have important significance in LDS.

Objective To explore the clinical application of computer-assisted three-dimensional navigation system for thoracic pedicle screw placement. Methods From May 2003 to May 2004, the computer-assisted three-dimensional navigation system was used for thoracic pedicle screw placement in 80 screws of 15 cases, including 30 in the upper thoracic spine and 50 in the middle or lower thoracic spine. These fifteen patients included ten male and five female with a mean age of 47 years (range 13-76 years). In this series of 15 patients, thoracic spinal surgery was performed for tumor resection and reconstruction in 5, burst fracture in 4, ossification of thoracic ligamentum flavum in 2 and thoracic scoliosis in 4. The pedicle screw position was assessed with "C"-arm fluoroscopy during operation and with CT post-operation. The cost of time for pedicle screw installation and amount of bleeding were recorded. Results The cost of time averaged 15 minutes (range 10-20 min) for each pedicle screw placement. The amount of bleeding varied, it averaged 1200 ml in thoracic tumor resection and reconstruction, 800 ml in posterior fixation for burst fracture, 300 ml in resection of ossified ligamentum flavum, and 500 ml in surgery for scoliosis. The pedicle screw position was graded post-operatively with CT scanning into three groups: gradeⅠ, perfectly placed, grade Ⅱ, cortical perforation less or equal to 2 mm, and grade Ⅲ, perforation more than 2 mm. Of these 80 screws, 76 screws (96%) were found in gradeⅠ, 2 in gradeⅡ, and 2 in grade Ⅲ. All of the 4 screws in gradeⅡor Ⅲ were placed deviating to the lateral portion of pedicles, and no neurological deficit was resulted. Conclusion The computer-assisted three-dimensional navigation system is a valuable tool both for improving the accuracy of thoracic pedicle screw installation, and increasing the overall safety of the procedure during thoracic spine surgery.

Objecfive To identify what factors contribute to the occurrence of avascular necrosis (AVN) of the femoral head after pediatric femoral neck fractures. Methods A series of 33 pediatric femoral neck fractures who had been admitted to our institution between June 1994 and April 2006 were retrospectively reviewed. There were 1 case of type Ⅰ,15 type Ⅱ,14 type Ⅲ and 2 type IV according to Delbet classification. The mean age at injury was 10.7(3.7 to 14.1) years, and the mean follow-up was 3.4(1 to 12.2)years. All patients were followed up until union was achieved. AVN occurred in 16 cases, including 8 cases of Ratliff type Ⅰ,3 of Ratliff type Ⅱ,4 of Ratliff type Ⅲ and 1 unclassified. Age at injury, fracture type, degree of displacement, quality of reduction and type of fixation were calculated and analyzed with respect to AVN. Results AVN occurred in 4 cases (36.4%)under 10 years old and in 12 cases (54.5%)10 years old or more. Eight cases (53.3%)of AVN occurred in Delbet type Ⅱ and 6 cases (42.9%) of AVN occurred in type Ⅲ.One case (25.0%)of AVN occurred in non-displaced group and 14 cases(53.8%)in displaced group. Ten cases(50.O%)of AVN occurred in the group whose reduction quality was satisfactory and 6 cases(66.7%)in unsatisfactory reduction group. Thirteen cases (48.1%)of AVN occurred in the unstable fixation group and 2 cases (50.0%)in the stable fixation group. Conclusion Fracture type, degree of displacement, quality of reduction and age at injury can affect the occurrence of AVN of the femoral head after pediatric femoral neck fractures.

OBJECTIVE:To observe the clinical efficacy and safety of caspofungin acetate in the treatment of invasive pulmo-nary fungal infection(IPFI). METHODS:70 patients with IPFI were selected and randomly divided into observation group(40 cas-es) and control group (30 cases). Control group was given Itraconazole injection with initial dose of 250 mg,bid,decreasing to 200 mg,qd,2 days later;observation group was given Caspofungin acetate injection 70 mg on the first day,decreasing to 50 mg, ivgtt,qd,within 1 h. Clinical efficacy,the rate of nacterial smear negative conversion and ADR were observed in 2 groups. RE-SULTS:The total effective rate of observation group was 92.50%,which was significantly higher than that of control group (76.67%);the rate of nacterial smear negative conversion was 72.00% in observation group,which was significantly higher than that of control group(42.10%);the incidence of ADR was 7.50%in observation group,which was significantly lower than that of control group (13.33%),with statistical significance (P<0.05). CONCLUSIONS:Caspofungin acetate is effective for IPFI with low incidence of ADR.

OBJECTIVE:To observe clinical efficacy and safety of rivaroxaban in the treatment of pulmonary embolism. METHODS:100 patients with pulmonary embolism were selected and randomly divided into observation group and control group, with 50 cases in each group. Both groups were given nursing intervention for rehabilitation. Observation group was treated with riva-roxaban 15 mg,bid,for consecutive 3 weeks,3 weeks later adjusting to 20 mg,qd;control group was given low molecular weight heparin 1 mg/kg,bid,combined with warfarin sodium 5 mg,qd,for more than 5 days,stopped taking low molecular weight heparin until the INR reached the target 2-3 and given warfarin alone orally. Treatment course of 2 groups lasted for 3 months. Clinical efficacy of 2 groups were observed,and PaO2,PaCO2 and D-dimer levels were observed in 2 groups before and af-ter treatment;the improvement of clinical symptoms as cough,pectoralgia,dyspnea,and the incidence of ADR were recorded in 2 groups. RESULTS:The total effective rate of observation group (90.0%) was significantly higher than that of control group (74.0%),with statistical significance(P<0.05). After treatment,PaO2,PaCO2 and D-dimer levels of 2 groups were increased signif-icantly,compared with before treatment;the observation group was higher than the control group,with statistical significance(P<0.05). The remission rate of clinical symptoms as cough,pectoralgia,dyspnea in observation group was significantly higher than in control group,with statistical significance (P<0.05). The incidence of ADR in observation group (12.0%) was significantly lower than in control group (30.0%),with statistical significance (P<0.05). CONCLUSIONS:Rivaroxaban supplemented by reasonable nursing intervention can effectively improve clinical efficacy of patients with pulmonary embolism with low incidence of ADR.

Objective To investigate the role of dendritic cell (DC) subsets and T cell subpopulations expressing different intracellular cytokines in the pathogenesis of syphilis. Methods Flow cytometry was utilized to measure the frequencies of peripheral DC subsets and IFN-γ-, IL-2-, IL-4-, IL-10-expressing peripheral CD4+ and CD8+ T cell subpopulations in 20 patients with syphilis before and after therapy, and in 15 healthy human controls. Results The frequency of CD11c+ DC was significantly lower in pretreated patients than that in treated patients (P<0.01), but higher than that in the normal controls (P<0.05), and the same was true for the frequency of IFN-γ-expressing T cells, IL-2-expressing T cells, and IL-12-expressing T cells. By contrast, a decrease was noticed in the frequency of IL-4-expressing T cells and IL-10-expressing T cells in pretreated patients compared with that in the normal controls. Furthermore, in patients with syphilis, the frequency of CD11c+ and CD123+ DC was unrelated to the percentage of IFN-γ-expressing and IL-12- expressing T cells (both P>0.05). Conclusions IFN-γ, IL-2 and IL-12 may exert an immunoregnlatory effect in the eliminating of Treponema pallidum, whereas IL-4 and IL-10 may perform an imrnunoinhibitory effect.

Objective To evaluate the gastroesophageal reflux symptom in patients who underwent continuous ambulatory peritoneal dialysis (CAPD) and the efficacy of proton pump inhibitor (PPI) in treating gastroesophageal reflux. Methods Fifty-eight CAPD patients with good clinical and complete dialyzed eondition,who was admitted to the hospital between Jan. 2008 and July 2008, were inquired about their gastroesophageal reflux symptoms using reflux disease questionnaire (RDQ). The patients who had RDQ≥6 and <12 were received esomeprazole 20 mg daily, while those with RDQ≥12 were received esomeparzole 20 mg twice daily. RDQ score was reevaluated 4 weeks after treatment.Results The common symptom was regurgitation (64.70%), followed by acid reflux (52.9 %), non-cardic chest pain (47.1. %) and heart burn (17. 6%). After 4-week treatment, the RDQ was significantly decreased (P< 0. 05). But there was no difference in outcome of treatment between patients with RDQ≥ 12 and RDQ< 12 (P=0. 059). Conclusion The gastroesophageal reflux symptom in CAPD patients can be relieved by PPI administration, but a larger clinical trial is needed to evaluate the course and efficacy of treatment.

The recent investigations have demonstrated that epigenetic such as DNA methylation and histone modification was closely associated with cell growth and malignant tumors, and epigenetic modification was responsible for an important cause of oncogenesis. However, for the recent years some observations have been also shown that the development of tumorigenesis was attributed to transformation expression in microRNA. The latest investigations have revealed that epigenetic was involved in modulation of microRNA expression, on the contrary some kinds of microRNAs could also control epigenetic, moreover, the reciprocal modulation between microRNA and epigenetic could regulate gene expression and induce tumorigenesis. At the same time the data likewise displayed that epigenetic adjusted microRNA expression principally in a way of DNA methylation or histone modification, nevertheless microRNA regulated epigenetic by way of methyltransferases expression, DNA methylation maintenance and histone modification. With regard to the reciprocal modulation between microRNA and epigenetic, a comprehensive and systemic review of reciprocal relationship in modulation of cell growth and oncogenesis was gived.

OBJECTIVE:To promote effective development of services in the intravenous drugs allocation centre and to bring the pharmacists'function into full play in the hospital pharmacy.METHODS:Information concerning services in the intravenous drugs allocation centre of our hospital and experiences from which was introduced,some problems and difficulties in the pharmacy services were analyzed.RESULTS&CONCLUSION:The centralized allocation and management of intra-venous drugs have ensured the safety and effectiveness of the clinical intravenous drug use and which have become the essential part of the pharmaceutical care with a core of rational drug use.