Background Both functional and morphological changes in amblyopic development are known to occur at various levels in the central visual pathway.However,whether the retina is involved or not during amblyopic progression remains controversial.Objective This study was designed to compare the thicknesses of the fovea and retinal nerve fiber layer (RNFL) of the normal fellow eye of amblyopic eye using optical coherence tomography (OCT) in children with myopic anisometropia.Methods Twenty-two patients with unilateral myopic anisometropic amblyopia were included as the anisometropia amblyopia group.Ten unilateral myopic anisometropic amblyopia subjects received treatment and recovered were used as the amblyopic cure group,and 11 individuals with simple myopic anisometropia without amblyopia were enrolled as the control group.OCT was performed on both eyes of all the subjects with informed consent.Fovea retinal thickness and RNFL thickness from the superior,inferior,nasal and temporal quadrants in the peripapillary region were evaluated.The measurement parameters were bilaterally compared in all the individuals by paired t test.The multiple regression model was used to analyze the correlation of retinal thickness with amblyopia patients.This study was approved by the Ethic Committee of this hospital.Written informed consent was obtain from each subject prior to the eye examination.Results Fovea retinal thickness increased in the amblyopic eyes compared with the fellow eyes,showing a statistically significant difference between them (P =0.001).However,no significant differences were found in the fovea retinal thickness between both eyes in the amblyopic cure group and simple myopic anisometropia without amblyopia group (P =0.778,0.943).Among the anisometropia amblyopia group,amblyopia cure group and simple myopic anisometropia without amblyopia group,the RNFL thicknesses of the temporal quadrant was significantly thicker in the higher myopic lateral eyes than those of the fellow eyes (P＜0.001,P =0.003,P =0.046).However,the differences in the superior,inferior,nasal and the average RNFL thickness were not statistically significant between the two eyes (P＞0.05).A negative correlation was found between the inferior retinal thickness with age (r=-0.559,P=0.016).Conclusions The fovea may be affected in unilateral myopic anisometropic amblyopia.There is no significant difference in the RNFL thickness between simple myopic eye and unilateral myopic anisometropia amblyopic eye.Improvement in amblyopia is coming along with the reduction of the thickness of the fovea.

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.

Objective To determine mercury contents in pair in cord blood,fetal hair,placenta and maternal scalp hair,and to analyze the correlation among them and the effect of mercury exposure risk factors in the mercury contents of samples.Methods Puerperants in the hospital,who lived in the local area without history of major diseases during the whole pregnancy,were investigated by questionnaire composed to several health factors.Cord blood,fetal hair,placenta and maternal scalp hair of these puerperal and their neonates (polyembryony and birth defects excluded) were collected to determine mercury content in pairs.Results The mean mercury contents of cord blood,fetal hair,placenta and maternal scalp hair in 303 samples were 1.65 μg/kg,234.58 μg/kg,3.85 μg/kg,497.62 μg/kg,respectively.Fifty percentile of them were 1.72 μg/kg,252.24 μg/kg,3.98 μg/kg,508.88 μg/kg,respectively.There were direct correlations between mercury in cord blood and that in fetal hair,mercury in cord blood and that in placenta,mercury in cord blood and that in maternal scalp hair,mercury in fetal hair and that in placenta,mercury in fetal hair and that in maternal scalp hair,mercury in maternal scalp hair and that in placenta(all P ＜ 0.05).The mercury contents in cord blood,fetal hair and maternal scalp hair of those living nearby factories involved in mercury,higher intake fish during the pregnancy,firing coal and consumption of whiting cosmetics and smoking were determined as (2.24 ± 0.20) μg/kg,(315.65 ± 35.31) μg/kg and (663.53 ± 71.83) μg/kg.The mercury in those without the high risk factors mentioned above were(1.62 ± 0.16) μg/kg,(245.79 ± 28.21) μg/kg and (499.39 ± 47.72) μg/kg.There was a significant difference between 2 groups(all P ＜ 0.01).Conclusions In addition to control industrial pollution,pregnant women should avoid the above-mentioned high risk factors and pay more attention to health care during pregnancy.The mercury content in cord blood is highly correlated with the mercury in fetal hair,and that in placenta and in maternal scalp hair.The 2 kinds of detection both can achieve the purpose of monitoring mercury intrauterine exposure conditions.

Objective To express, purify and refold recombinant luteinizing hormone releasing hormone-angiogenin(LHRH-Ang) toxin using E. coli. expression system. Methods Recombinant LHRHAng expression vector was constructed by replacing of EGF fragment in plasmid pET28a/EGF-Ang with LHRH-P Ⅱ fragment amplified from plasmid pET28/MSH-PEA0. DNA sequencing would be used to verify the correction of fused LHRH-P Ⅱ -Ang gene. Then, E. coli strain BI21 (DE3) was transformed by pET28a/LHRH-Ang vector. Expression of recombinant LHRH-Ang toxin was induced by Isopropyl-β-D-Thiogalactoside( IPTG ). Refolding effects of gradient dialysis was evaluated by SDS-PAGE. Results Prokaryotic expression vector pET28a/LHRH-Ang, containing LHRH-P Ⅱ -Ang fusion gene, was constructed by PCR amplification, restriction enzyme digestion and ligation method. Sequence correction of fusion gene was confirmed by DNA sequencing After IPGT induction, recombinant LHRH-Ang protein was expressed in BL21 ( DE3 ) as inclusion body ,it took 18.43% of total protein. Inclusion body was resolved in 8 mol/L urea and purified by DEAE-Sepharose FF column, the purity was 85%. Recombinant LHRH-Ang toxin was refolded and concentrated by gradient dialysis and PEG 20000, respectively. Conclusions Recombinant LHRH-Ang protein was expressed in E. coli and refolded successfully.

Objective To explore the conception,mechanism,clinical manifestations,diagnosis,treatment and prognosis of ectopic pituitary adenoma. Methods The clinical data of 3 patients with ectopic pituitary adenoma, admitted to our hospital from October 2010 to March 2011, were retrospectively analyzed and discussed by reviewing the relevant literature. Results Clinical manifestations ofectopic pituitary adenoma were as follows:2 had headache,1 had sexual dysfunction and blurred vision, and 1 had acromegalia combined with psychiatric symptom. Endocrinological examination showed that 1 had obviously increased growth hormone (GH) and 1 increased prolactin (PRL).MRI scan indicated that 2 were located in sphenoid sinus and I was located in the sphenoid sinus and clivus.Contrast-enhanced MRI showed enhanced lesions.Total removal was achieved in 2 patients through the trans-sphenoidal approach; partial removal was achieved in the patient with sphenoid sinus and clivus.Pathology examination demonstrated as pituitary adenomas. Conclusion The patients with ectopic pituitary adenoma have neurological dysfunction or/and endocrinological dysfunction; CT and MRI play valuable role in their diagnosis; radical resection of tumor can achieve satisfactory clinical outcomes.

Objective To explore the etiology,clinical presentation and treatment of patients with spontaneous spinal epidural hematoma (SSEH). Methods Twelve patients diagnosed as having SSEH, admitted to our hospital from January 1995 to December 2010, were chosen in our study; 10 underwent surgical operation and 2 chose conversational therapy; the characteristics of onset,clinical presentations, diagnosis, treatment and results of follow-up were analyzed. Results No obvious reasons induced the onset of SSEH in these patients and all manifested as loss/decrement of myodynamia of the involved limbs,and bowel and bladder dysfunctions.Follow-up was performed for 6-18 months; 2 patients received hematoma lesion dissection by spinal canal decompression enjoyed entire recovery of neural dysfunction, while 8 showed no significant amelioration in spinal cord function besides mild improvement of bowel and bladder function; in the 2 patients chosing conversational therapy,1 achieved total recover of the nerve funtion and the other one partially recovered. Conclusion The etiology of SSEH remains indefinite and the prognosis is usually disappointed; permanent spinal cord dysfunction is seemly inevitable in most cases; prompt surgical intervention are of great importance for prognosis of SSEH and should be the first choice of therapy.

Objective To report a new approach,endoscopic transoral approach for the resection of jugular foramen schwannoma.Methods Nine patients with jugular foramen schwannoma ( three males and six females,ranging in age from 15 to 61 years old ) were treated by direct surgery via a pure endoscopic transoral approach to the jugular foramen. Eight patients complained of hypoglossal nerve palsy with hemiatrophy of the tongue; six cases complained of vagus nerve palsy. Three cases complained of glossopharyngeal nerve palsy,one case complained of facial nerve palsy and hearing loss.Results The nerves in this area were preserved and radical intracapsular removal of the tumor was performed via endoscopic transoral approach in the nine cases.Tumor removal,as assessed by intraoperative endoscopic inspection,postoperative magnetic resonance imaging and clinical evaluation,revealed all tumors were completely removed.One patient suffered from temporary swallowing difficulties and temporary right vagus palsy Ⅰ day after surgery.There were no others intraoperative and postoperative complications.All patients were followed up for 4 -29 months,no recurrences were occured in all these patients and the muscle bulk,motor and the pre-postoperative swallowing fuction,the vagus palsy,the facial nerve palsy and hearing loss had improved in these patients.Conclusion The endoscopic transoral approach and intracapsular removal of the tumor provided for successful minimally invasive surgery in the jugular foramen schwannomas.

Purpose To investigate the consistency and clinicopathologic correlation of BRAFV600E protein expression and gene mutation in papillary thyroid carcinoma. Methods BRAFV600E protein expression and genn mutation was detected respectively by immunohistochemistry of SP and real time-PCR, then the consistency between the both methods was analyzed by Kappa-test, the correlation between BRAFV600E and clinicopatho-logic parameters was analyzed by Chi-square test in papillary thyroid carcinoma. Results The gene mutation and protein expression rates of BRAFV600E were 89.3％ and 88.3％, respec-tively, the differences were not significant, the concordance rate of the both methods was 97.0％, Kappa value was 0.847, the consistence was higher, meanwhile the mutation rates between age ＜45 and ≥45 were respectively 96.8％ and 85.9％, there were significant differences, the positive rates of the both detec-tion methods were higher in thyroid capsule invaded group than non-invaded group, the differences were significant. Conclusion The both methods have higher consistency, the immunohisto-chemistry can be used as an initial screening tool for detecting gene mutation, the gene mutation of BRAFV600E is significantly associated with age and capsule invasion, the relationship is not found between BRAFV600E mutation and the other clinicopatholog-ic parameters.

Objective To investigate the expression changes of myeloid-related protein-8 (MRP-8) and myeloid-related protein-14 (MRP-14) in children with Kawasaki disease (KD) and to obtain laboratory diagnostic serum markers and new targets for its drug therapy.Methods A total of 46 patients with KD(KD group) were enrolled from Jul.2009 to Dec.2010 and divided into the coronary artery dilatation(CAD) group(n =15) and the normal coronary artery group(n =31) ;Meanwhile,25 febrile patients with acute respiratory tract infection but without disease in the circulatory,blood,immune systems formed the non-KD febrile group.Twenty healthy children from the out-patient department formed the healthy control group.Peripheral venous blood was collected in the acute and subacute stage of KD.Levels of MRP-8/MRP-14 were detected with enzyme-linked immunosorbnent assay (ELISA).Gene expressions of MRP-8,MRP-14 in leukocytes were analyzed by semi-quantitative reverse transcription-polymerase chain reaction(RTPCR).Results The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in the leukocytes in the out-patient acute and subacute stage of KD were significantly higher than those in the non-KD febrile group and the healthy control group(all P ＜ 0.05) ;There was no significant difference between non-KD febrile group and healthy control group (P ＞ 0.05).The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in leukocyte in actue stage of KD were significantly higher than those in subacute stage(all P ＜ 0.001).The serum levels of MRP-8/MRP-14 as well as mRNA expressions of MRP-8 and MRP-14 in the acute and the subacute stage of CAD group were significantly higher than those in the normal coronary artery group(P ＜ 0.05).Conclusions MRP-8/MRP-14 may probably play a role in the pathogenesis of KD and can be used as a diagnostic indicator for KD;MRP-8/MRP-14 may be involved in the formation of coronary artery lesion and can be used as an effective predictor for the coronary artery lesion.

Objective To investigate the feasibility and efficacy of tubed pectoralis major myocutaneous flap in the reconstruction of circumferential defects following resection for locally advanced hypopharygeal and cervical esophageal carcinoma. Methods From Dec. 2004 to Oct 2008, 30 patients underwent immediate reconstruction by tubed pectoralis major myocutaneous flap for circumferential defects following resection of primary tumours. Among them, 22 were hypopharyngeal carcinoma, 7 were cervical esophageal carcinoma and one was recurrent laryngeal carcinoma involved the hypopharyngeal lumen. Five of 30 patients had received previous radiotherapy and three had failed in the previous surgical procedure. In this series, 12 patients had total pharyngolaryngectomy and 18 had total pharyngolaryngectomy and partial cervical esophagectomy. Results Postoperative pharyngocutanous fistula formation occurred in 4 patients, 2 of them with previous radiotherapy and 2 with diabetes, and the fistulae healed later. Two patients developed anastomotic strictures at the upper junction, but they had good respondses to dilatation treatment and had satisfactory oral intake. The postoperative follow-up time ranged from 8 to 56 months. Median follow-up was 18 months. One-year survival rate was 71.4% and three-year survival rate was 42.5%. Conclusions The tubed pectoralis major myocutaneous flap is a reliable procedure to reconstruct hypopharyngeal circumferential defects following resection of advanced hypopharygeal and cervical esophageal carcinoma. This method may be the optimal choice for the reconstruction of hypopharyngeal circumferential defects following resection of recurrent carcinoma. The incidence of fistula and stenosis could be kept at an acceptable level.