AIM: To investigate the effectiveness and safety of intravitreal injection of anti-vascular endothelial growth factors (VEGF) drugs to the patients with proliferative diabetic retinopathy before vitrectomy treatment.METHODS: A Meta-analysis.A comprehensive retrieval was conducted using the database including EMbase,the Cochrane Library,Pubmed,CBM,WanFang Database,CNKI and so on.The retrieval time was limited from the building time of database to Jan.2017.The randomized controlled trial was adopted with no requirements on languages.The Jadad scale and Cochrance cooperation were used as the tool of the risk and bias evaluation to analyze the literature quality.Quality estimation of evidence-based medicine on the parameters of each evaluation index was made via GRADEpro Software.The publishing biases of enclosed documents were inspected with funnel plot.At last,the Meta analysis was conducted with Review Manager 5.3.RESULTS: Totally 16 literatures published from 2008-2016 were finally put into randomized controlled trial.A total of 923 cases were included,among which 493 cases were grouped as intravitreal injection of anti-VEGF before the combined operation of PPV group (the experimental group),and 430 cases were involved in simple PPV group (the control group).The results of Meta-analysis show: (1) The probability of intraoperative bleeding was remarkably lower than the control group [OR=0.06,95%CI (0.02,0.15),P<0.01],with statistically significant differences.(2) The duration of operation was obviously shorter than that of the control group[WMD=-29.13,95% CI (-36.95,-21.30),P<0.01],with statistically significant differences.(3) The probabilities of both early and late postoperative vitreous hemorrhage were lower than those of the control group[OR=0.34,95%CI (0.20,0.58),P<0.01],with highly statistically significant differences.(4) The best corrected visual acuity after surgery was no better than that of the control group,[WMD=-0.51(LogMAR),95%CI(-1.10,0.08),P=0.09] with no statistical significance.(5) The occurrence of iatrogenic retinal rupture was lower than that of the control group[OR=0.24,95%CI(0.14,0.40),P<0.01],with statistically significant differences.(6)Among the 493 patients included in the 16 literature,no case of ocular and general adverse effects due to anti-VEGF injections was reported.CONCLUSION: It is effective and safe for the patients with proliferative diabetic retinopathy to inject anti-VEGF drugs into vitreous cavity before vitrectomy.And it can reduce the occurrence of complications during and after surgery,improving the general treatment effects.However,the specific implementation plans,such as the injection does,the interval between the injection and the operation and so on,still need further exploration and perfection.

The corneal reconstruction is tosurgial recover the structure integrity and corneal function after suffered from various trauma, inflammation and degenerative diseases.The corneal diseases caused millions of people worldwide suffering from eyesight damages and even blindness.At present, the corneal transplant is the main therapy for corneal blindness.However, the shortage in donor corneal issue is a worldwide problem and the failure due to the immunologic rejection of host is common.Nowadays, with the development of tissue culture and bioengineering technology, the application prospect of autologous stem cell transplantation is becoming more and more popular which might replace the allogeneic transplantation, becoming an important clinical treatment of regenerative medicine.Human dental pulp stem cells (hDPSCs) is a class of adult stem cell divided from the third molar teeth.Both hDPSCs and corneal cell are from the cranial nerve in embryonic ectoderm.Extensive researches show that the hDPSCs have the potentialities in corneal cell differentiation without causing immunologic rejection of the recipient.These findings manifested the potentials of hDPSCs in the clinical applications related to ocular surface reconstruction.In this paper, the features and current investigation status of hDPSCs in ocular surface reconstruction are reviewed.

Objective To investigate the application of high frequency ultrasound in knee joint lesions of elderly patients with rheumatoid arthritis.Methods Fifty patients with rheumatoid arthritis were collected in Yangpu Hospital Affiliated to Tongji University from March 2015 to December 2016 as test group.Fifty healthy elderly people without knee joint lesion were randomly selected as control group.High frequency ultrasound was used to examine the patients in the test group and the Results of this examination were used to compare with those of the control group and observe four indexes: patellofemoral effusion,synovial thickness,cartilage thickness and blood flow in the lesion area.Results There was only a small amount of synovial fluid in the articular cavity in the control group,the thickness was (2.11± 0.94) mm,while the thickness of the test group was (10.33±2.74) mm,the difference was statistically significant (t=17.03,P<0.05);in the control group,there was no synovial hyperplasia,the thickness was (1.11±0.24) mm,while the thickness of the test group was (5.48±2.74) mm which was significantly higher than that of the control group (t=13.18,P<0.05);in the control group,the cartilage tissue was striated without echo band,the thickness was (1.76±0.29) mm,while the cartilage tissue of the experimental group had lesion,the thickness was (1.12±0.12) mm lower than that of the control group and the difference was statistically significant (t=6.44,P<0.05);in the control group,there was no blood flow signal in the joint cavity,while low-speed blood flow signal could be seen in the joint cavity of the test group,the difference was statistically significant (0 vs.96%,χ2=6.44,P<0.05).Conclusion High frequency ultrasonography is effective in the treatment of senile rheumatoid arthritis with high specificity,high sensitivity,low cost,high efficiency and simple operation and it is not subject to external conditions.Therefore,it is suitable for early examination of senile rheumatoid arthritis and clinical promotion.

The normal growth of blood vessels is the result of dynamic balance of angiogenic factor and inhibitory factor in vascular tissue.However, when the balance is broken, the growth of new blood vessels will be induced.Endogenous angiogenesis inhibitory factor, is a group of negative feedback molecules produced by the body itself that inhibit angiogenesis.Its function of inhibiting angiogenesis is mainly realized by promoting the binding of angiogenic factor to its receptor, or its downstream angiogenesis signal, or promoting vascular endothelial apoptosis.The study of angiogenesis inhibitory factor has potential clinical significance for the prevention and treatment of retinal neovascularization.Recent studies on retinal neovascularization inhibitory factor are reviewed in this paper.

Objective To observe the effect of astragalus polysaccharides ( APS) on glucose homeostasis regulation and focus on glycogen synthase kinase 3 beta (GSK3 beta) activity and subcellular localization (nuclear translocation).Methods HepG2 human hepatoma cells were cultured in vitro and treated with high glucose of different concentrations (30, 40 mM) to induce hepatocyte endoplasmic reticulum stress model, then acquire optimum operating concentration.The HepG2 cells were treated with APS of different concentrations (50, 100, 200, 400 μg/mL) to select the most effective concentration.The HepG2 cells were divided into seven groups with different treatment: negative control group (C), positive control group (Tm), 30 mM high glucose-induced group (G30), 45 mM high glucose-induced group (G45), negative control+APS group (CA), positive control+APS group ( TA) and high glucose-induced+APS group ( GA).Effect of APS at different concentrations on proliferation activity of HepG2 cells were detected by MTT assay, transcription and shear levels of XBPlmRNA in HepG2 cells by quantitative real-time PCR, and phosphorylation levels of GSK3βin cytoplasm and nucleus by immunoblotting techniques.Results The optimum operating glucose concentration was 30 mM.The most effective APS concentration was 200μg/mL.The transcription and shear levels of XBPlmRNA in HepG2 cells of GA group were lower than those of G30 group ( P<0.05), respectively, but there were no significant differences between TA and Tm group.The phosphorylation levels of GSK3βin cytoplasm and nucleus of GA group were higher than those of G group(P<0.05), respectively, but there were no significant differences between TA and Tm group. Conclusion APS could improve hepatic steatosis, and its mechanism might be that APS inhibits the activity and nuclear localization of GSK3β, then alleviate endoplasmic reticulum stress.

Objective To explore the clinical method and effect of ultrasonic osteotomy in mandibular angle reduction.Methods Under intronasal approach and general anesthesia,30 patients (5 male patients and 25 female patients) underwent intraoral prominent mandibular angle reductions with ultrasonic osteotomy.The jaw bone under periosteum was explored and the mental nerves protected.According to the clinical features of mandibular angle,curved mandibular angle osteotomy,mandible margin osteotomy or outer cotex splitting osteotomy were performed.Results All the osteotomy of prominent mandibular angle reductions could be completed with ultrasonic osteotomy.There were no complications of bleeding,nerve injury and malfracture happened.After 1 year following-up,the outlines of lower mandible were natural and concordant.Compared with traditional osteotomy devices,ultrasonic osteotomy was smoother and more precisely.Conclusions Ultrasonic osteotomy can improve the precise and safty of mandibular angle reduction.but compared with traditional osteotomy devices,it takes more time for osteotomy procedure.Surgeons need adapt to the different feeling and control methods.

Objective To analyze risk factors for soft-tissue defects after surgery on leg trauma,to discuss methods for prevention of soft-tissue defects and its treatment.Methods A retrospective analysis was conducted on 217 cases of soft-tissue defects with bone exposure and / or internal fixation exposure after surgery on leg trauma from January,1999 to December,2012.Soft-tissue defects with various flaps were used in 201 cases,including neurocutaneous flap(89 cases),random flap(21 cases),free flap(75 cases),cross-leg flap(16 cases),and by skin grafting in 16 cases.For the 117 internal plate-fixated fractures,96 removed the plate and 21 cases did not remove the plate.For the 13 intramedullary nail fixations,4 cases of intramedullary nails were removed,9 cases were not removed.For the 56 cases of external fixation of the fractures,39 patients had unadjusted external fixation,17 cases re-adjusted external fixations.Results Of the 217 cases of soft-tissue defect after surgery on legs,201 cases were conducted flap surgery.The flap was completely necrosis in one case,and partial distal necrosis were in 14 cases,of which 6 cases healed after changing the dressing,5 underwent debridement and skin grafting,3 cases underwent flap surgery again.In cases of fracture patients,177 cases healed within 1 year,delayed union 23 cases,nonunion eight cases.Nonunion healing after bone grafting and re-fixation surgery.In 9 cases of uncontrollable osteomyelitis,6 patients underwent bone removal and bone transport surgery,3 patients underwent amputation.Conclusion Soft-tissue defects after surgery on leg trauma is a serious complication whose prevalence is associated,in a certain degree,with incorrect surgical time and methods.It is crucial for early repair of soft-tissue defects by using various kinds of proper flaps whenever soft-tissue complication occurs.In patients with early stage internal fixation,flap surgery without internal fixation removing is feasible if little soft-tissue defect,little exposed internal fixation and mild infection,otherwise it is necessary to remove internal fixation and re-fix by external fixation before flap surgery.

BACKGROUND:Individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization are common methods for treating nondisplaced wrist scaphoid fracture. However their clinical outcomes are stil unclear. ＜br> OBJECTIVE:To compare the clinical results of individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization for treatment of Herbert type Ib scaphoid fracture. ＜br> METHODS:A total of 36 patients with fresh Herbert type Ib scaphoid fracture were divided into two groups, individualized percutaneous cannulated screws fixation with the help of computer-assisted design group (screw group, 20 cases) and cast immobilization group (cast group, 16 cases). In the screw group, cannulated screws were inserted using 0.8 mm kirschner wires from scaphoid tuberosity based on the preoperative individualization fixation parameters. The direction of the wires was guided under C-arms and Herbert screws were percutaneously immobilized after fluoroscopy. In the cast group, radial deviation and palmar flexion plaster casts were immobilized for 3 months. The time of bone union, rate of bone nonunion, time return to work, wrist motion were recorded and compared in the fol ow-up. ＜br> RESULTS AND CONCLUSION:Al cases were fol owed for 10-24 months. Al patients in the screw fixation group and 13 out of 16 patients in the cast group achieved bone union. The average time of bone union of the two groups was 6 weeks and 14 weeks respectively (P＜0.001). The time of returning to work was 7.6 weeks and 16.8 weeks respectively, with significant differences between the two groups (P＜0.001). The range of motion of screw fixation group at the final fol ow-up was 96.4°-114.4°, average 104.4°, which was significantly higher than that in the cast group (66.4°-104.2°, average 94.2°;P＜0.001). Individualized percutaneous cannulated screws fixation with the help of computer-assisted design can provide mini-invasion, high accuracy and good reproducibility, has better results than cast immobilization in the treatment of Herbert typeⅠscaphoid fractures.

ObjectiveTo investigate the efifcacy of alarm treatment in a sample of China monosymptomatic nocturnal enuresis (MNE) children and adolescents with smaller than expected bladder capacity (EBC) for age.Methods Fifteen MNE pa-tients with a smaller than age-expected BC and without nocturia were included. All the patients were treated with enuretic alarm and water restriction 2 hours before sleep. All patients were followed up monthly. A success criterion was deifned as “14 con-secutive dry nights” after successive 2-3 months treatment. A relapse criterion was deifned as “more than two wet nights every two weeks” after therapy discontinuation. The relapsed patients were treated with enuretic alarm and followed up again.Results The patients consisted of 9 boys and 6 girls. The mean age was 9.76±4.24 years (6-15 years). Thirteen patients were successfully cured after three months treatment. Two patients discontinued the treatment and received the treatment of desmopressin. Five patients relapsed and received the enuresis alarm treatment again. Four patients had never relapsed, and one failed. The cure rate was 80%.Conclusions The enuretic alarm device is effective on MNE patients with a smaller than age-expected BC and without nocturia.

Objective To investigate the safety of different intensity anticoagulation therapy of warfarin in preventing thromboembolism in octogenarian patients with nonvalvular atrial fibrillation (NVAF). Methods The 130 patients with persistent or permanent NVAF were randomly divided into three groups: low-intensity warfarin group (35 cases, international normalized ratio, INR (1.5-2.0), moderate-intensity warfarin group (32 cases, INR 2.1-2.5) and aspirin control group (63 cases). The rate of hemorrhagic events and the effect on renal function were observed. Results The incidence of hemorrhage was the lowest in low-intensity warfarin group compared to the other groups with slight bleeding in one case. life-threatening bleeding in one case, severe bleeding in one case and slight bleeding in four cases occurred in moderate-intensity warfarin group. Life-threatening bleeding in three cases, severe bleeding in two cases and slight bleeding in six cases occurred in aspirin control group. There were significant differences in bleeding incidence among the three groups (χ2=5.13,P＜0.05). The low-intensity warfarin group and moderate-intensity warfarin group were superior to the aspirin control group in the effect on renal function (P＜0.05). Conclusions It is safe that the dose of warfarin is maintained at low anticoagulation intensity between INR 1.5 and 2.0 in octogenarians with NVAF.