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.

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 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.

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 This study on a medium-fidelity simulator (SimMan , Laerdal Medical Corpo-ration,Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by residents of anesthesiology and the effect of training in this context.Methods 30 residents of anesthesiology were devided into two groups (T and E). There were two scenarios investigated:'can't intubate, can oxygenate'(CI) and'can't intubate, can't oxygenate'(CICO). The E group was trained by scene simulation in the second, fourth, sixth month respectively before and after the training, and the T group received the same situation simulation training on the same day after the theoretical training and in the second, sixth month after the training. In con-trast to standard operating procedures, the performance of two groups of trainees was recorded on the basis of pre established evaluation criteria. Data differences between the two groups were analyzed using SPSS 23.0,t test, M-W test andx2 test.ResultIn CI, success rate of placement of astandard and intubating laryngeal mask air-way were high in T group (87％ vs. 55％ ,P=0.037). This was sustained over time. There was no difference in duration and incidence of desaturation between two groups. In CICO, there was a more structured approach following training in T group (P<0.05), which wasn't sustained over time. But this was sustained over 6 months in E group.ConclusionSituational simulation training can significantly improve the anesthesiology residents' ability to take proper response measures to the unexpected difficult airway, and significantly shorten the training time for emergency airway treatment. Repeated situational simulation training should be conducted at intervals of 2 months or less, allowing residents to maintain emergency response to the emergency airway.

ObjectiveTo investigate the correlation of brainstem auditory evoked potentials(BAEP) and somatic evoked potentials (SEP) with therapeutic outcome of brain stem hemorrhage patients.MethodsBAEP and SEP were detected in the early period of 25 caees with brain stem hemorrhage by evoked potential instrument,and were surveilled dynamically.ResultsThere was good prognosis in the patients whose BAEP and SEP were normal in the first time and repeated detection.Poor prognosis happened in ones whose BAEP and SEP were abnormal in the first time and repeated detection.The difference was significant between them(P＜0.05).ConclusionCombined detection and dynamic surveillance of BAEP and SEP could predict accurately the curative result of patients with brain stem hemorrhage.

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.

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

OBJECTIVE: To improve the checking management of outpatient pharmacy and to reduce the error rates of checking process. METHODS: With the data from "Army No 1" hospital information system, to designe dynamic checking table ordered by fixed location of each drugs in containers, and pending prescription transfer database is established to manage unconfirmed expired prescriptions. RESULTS & CONCLUSIONS: The order of name in the stock table of drugs is identified to the position of each drug in containers. There is no requirement for incorporate check-in operation of the same kind of drugs from various manufactories and identification of their locations. Taken advantage of computer technology, this checking program is more time-saving, simple and easy, and significantly increases the accuracy of results.