Attention is being paid to the treatment of hyperopia(presbyopia) with laser thermokeratoplasty.This article mainly presents the theory of laser thermokeratoplasty(LTK),equipment configuration and some key techniques in laser delivery system.

Plasma VEGF level of T2DM was higher than that of normal control （NC, n=30） and progressively increases from normal albuminuria （NA, n=26） to microalbuminuria （MA,n=26） and to macroalbu-minuria （ODN, n=24） groups, The VEGF level was positively correlated with the levels of creatinine, HbA1c and UAER and, decreases after losartan treatment in groups of MA and ODN.

Objective:To analyze dermoscopic and reflectance confocal microscopic characteristics of acanthosis nigricans, and to assess the value of dermoscopy and reflectance confocal microscopy (RCM) in the auxiliary diagnosis of acanthosis nigricans.Methods:A total of 63 patients with acanthosis nigricans were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2018 to December 2019, and 5 healthy individuals served as controls. Two lesions on the neck and axilla were examined with dermoscopy and RCM separately in each patient. Biopsies were carried out at the sites evaluated by dermoscopy and RCM in 3 patients, followed by routine histopathological examination.Results:Dermoscopy showed papilloma-like hyperplasia in 126 (100%) lesions, "fat finger" structures in 119 (94.4%) , and "gully" structures in 120 (95.2%) . RCM showed hyperpigmentation in the basal layers, downward extension and twisting of dermal papillary rings and "gully" structures in 126 (100%) lesions, moderately to highly refractive particles in the dermal papillary rings in 87 (69.0%) .Conclusion:Acanthosis nigricans has typical dermoscopic and reflectance confocal microscopic characteristics, which can provide a basis for its diagnosis and differential diagnosis.

To study the effect of the proliferation and apoptosis of Survivin-T34A mutant on breast cancer MCF-7 cell, we adopted the method of cell culture in vitro to observe the proliferation and apoptosis of the cell. In the experiment, MCF-7 cells were randomly divided into three groups and transfected with normal saline, PORF-9-null and Survivin-T34A, respectively. Breast cancer nude mouse models were established to study anti-tumor effect of Survivin-T34A in vivo. The activity of the cells in the Survivin-T34A-transfected group was lower than that in PORF-9-null group. The increase of cell apoptosis was observed under electron microscopy, meanwhile the apoptotic rate was obviously higher than that in PORF-9-null control by flow cytometry. Tumor inhibition effects of the mouse which received the injection of Survivin-T34A intratumoral injection were apparent, and the inhibition ratio was as high as 47.1%. In conclusion, Survivin-T34A mutant has anti-tumor effect through efficiently inhibiting the growth of breast cancer MCF-7 cell and actively promoting apoptosis of cancer cells.
Animals ; Apoptosis ; Breast Neoplasms ; drug therapy ; pathology ; Humans ; Inhibitor of Apoptosis Proteins ; genetics ; pharmacology ; Injections, Intralesional ; Mice ; Mice, Nude ; Neoplasm Transplantation ; Transfection

Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor is recently added to the list of effective lipid-lowering drugs in addition to statins, which can reduce low density lipoprotein cholesterol, treat increased low density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) patients. In the past 30 years, the prevalence of dyslipidemia increased significantly. LDL-C characterized dyslipidemia is an important risk factor of ASCVD and a part of metabolic syndrome, which exists before or after or at the same time of the appearance of obesity, diabetes, and glucose intolerance, coronary heart disease and other diseases. Decreasing LDL-C level can significantly reduce the incidence and mortality risk of ASCVD. In this paper, the research on the regulation of dyslipidemia by PCSK9 inhibitors is discussed.

Objective:To investigate the effects of enteral nutrition assisted therapy in preventing postoperative anastomotic fistula in patients with esophageal cancer and its influence on immunity,healing process and nutritional recovery.Methods: The clinical data of 90 cases of patients with esophageal cancer who underwent surgical treatment were retrospectively analyzed.According to the mode of postoperative nutritional support,the patients were divided into group A(n=34),B(n=30)and C(n=26)three groups.Group A was treated by immune-enhancing enteral nutrition(Supportan)assisted therapy.Group B was treated with routine enternal nutrition(Nutrison Fibre)assisted therapy.Both of the two groups were treated with 25%,50% and 100% of the full dose on the 1st,2nd and 3rd-7th day after surgery.Later,the dose was reduced day by day till normal diet.Group C was treated by parenteral nutrition assisted therapy.Since the 1st day after surgery,patients in group C were intravenously injected with glucose,vita min and a mino acid mixed liquid calculated by 125.52 kJ/kg.8-10 d later,patients gradually transited to the normal diet.The incidence rates of anastomotic fistula,pulmonary infection and incision infection,wound healing time,total hospitalization time and initial exhaust time were observed and compared between the three groups.The changes of immune index [T lymphocytes and its subsets(CD3+,CD4+,CD8+)],inflammatory factors[C reactive protein(CRP),IL-6]and nutrition indexes[serum total protein(TP),albumin(ALB)]before surgery,on the 1st and 8th day after surgery were recorded.Results: ①There were significant differences in the incidence rates of postoperative anastomotic fistula and pulmonary infection between the three groups(P<0.05),and the incidence rates in group C were significantly higher than those in the other two groups(P<0.05).②There were significant differences in wound healing time,total hospitalization time and initial exhaust time between the three groups(P<0.05)and that of group C group was longer than that of the other two groups(P<0.05).③On the 1st day after surgery,the levels of immune indexes such as CD3+,CD4+,CD4+/CD8+ and nutrition indexes such as TP and ALB in the three groups were significantly lower than those before surgery.CD8+ levels and levels of inflammatory indexes such as CRP and IL-6 were significantly higher than those before surgery(P<0.05).However,there was no significant difference between the groups(P>0.05).On the 8th day after surgery,the nutrition indexes in the three groups were still significantly lower than those before surgery.However,those in group A and B were significantly higher than those in group C(P<0.05);the inflammatory factors were still significantly higher than those before surgery(P<0.05)but those in group A and B were significantly lower than those in group C(P<0.05).Among the three groups,there was no statistical significance in comparing the immune indexes with those in group A(P>0.05).The levels of CD3+,CD4+,CD4+/CD8+ in the other two groups were lower than those before surgery while CD8+ level was higher than that before surgery(P<0.05).Conclusion: To apply enteral nutrition assisted therapy in patients with esophageal cancer after surgery can effectively improve the prognosis.It has positive effects on shortening the healing process,improving the immune function and improving the nutritional status.

Objective To study on the research focus of angiotensin converting enzyme inhibitor(ACEI) and calcium channel blocker.Methods From 1999 to 2008,the literature which the "angiotensin converting enzyme inhibitor"and"angiotensin converting enzyme inhibitor" in SCI database were collected.CiteSpace visualization techniques were uesd to analyze hot fields,hot spot of the author and the hot article on two types of the drugs.Results There were 5 hot fields on two type of drugs,respectively were theray,ACEI,hypentesion,CCB and randomized-trial.The most frequent intermediate words were hypentesion and mortality,etc.The hotest fields were HARVARD UNIV and UNIV MILAN respectively,and the hotest magazine were Hypentesion,Hypentesions Rev respectively.Conclusion CiteSpace visualization techniques can make a scitific conclusion on ACEI and CCB.

BACKGROUND: There are many clinical applications of oral medication in treatment of primary osteoporosis, but there are few reports on integration of point injection and electric acupuncture in treatment of primary osteoporosis.OBJECTIVE: To observe the effects of intervention with point injection and electric acupuncture on the basis of western drug on primary osteoporosis and to compare the therapeutic effects with simple western medical treatment.DESIGN: Case comparison was designed.SETTING: Hygiene Clinic of Engineering College of Nanjing University of Agriculture and First Affiliated Hospital to Nanjing University of Medical Sciences.PARTICIPANTS: Totally 46 cases of primary osteoporosis were selected from the outpatients in Hygiene Clinic of Engineering College of Nanjing University of Agriculture from April 2000 to June 2004 and all of the cases were in the observation voluntarily. Two groups were randomized according to visiting sequence, named acupuncture+drug group (23 cases), aged (67±4) years and drug group (23 cases), aged (66±5) years.METHODS: ① In acupuncture+drug group, on the basis of medication of alfacalcidol and calcium carbonate, the integrative therapy of point injection and electric acupuncture was applied. Pont injection: Xue-saitong zhusheye was injected on zusanli (ST 36), iaixi (KI 3), sanyinjiao (SP 6) and xuanzhong (GB 39) 1.67-3.33 cm in depth. Two points were selected each time and 2 mL on each point, once/day and the points were injected bilaterally and alternatively. Electric acupuncture:The points were pishu (BL21), shenshu (BL 23) and qihaishu (BL24).Electric apparatus was attached on the points after arrival of qi, with continuous wave, 2 Hz, 30 minutes, once a day. One month treatment for either point injection or electric acupuncture was taken as one course.The second course was followed afterbreak for 5 days. Totally, 6 months were required. Western medical treatment: α Vit. D3 0.5 μg per day was administrated orally, onceaday and calcium carbonate, 1 tablet, once a day,continuously for 6 months. ② Drug control: Only western drugs were administrated orally and the usage was same as the acupuncture +drug group. The patients in two groups were treated for 6 months. Bone mineral density (BMD) of L2-4 and upper end of femur was assayed with X-Ray absorptiometry.MAIN OUTCOME MEASURES: BMD of L2-4 and upper end of femur before and 6 months after treatment in two groups.RESULTS: All of 46 cases of primary osteoporosis entered result analysis, no dropped out case. ① Comparison of BMD of lumbar vertebras before and 6 months after treatment in two groups: After 6-month treatment,in acupuncture +drug group, BMD of L2-4 was improved significantly [(0.829±0.049), (0.791±0.043) g/cm2, (t=2.80, P ＜ 0.01)] compared with that before the treatment. In drug control, BMD of L2-4 was improved significantly [(0.813±0.051), (0.788±0.048) g/cm2, (t=1.71, P ＜ 0.05)]compared with that before the treatment. Concerning to the variations of BMD between two groups, the variation in acupuncuture+drug group was more than that in drug control [(0.038±0.020), (0.025±0.025) g/cm2 (t=1.95,P ＜ 0.05)]. ②) Comparison of BMD of femur before and 6 months after treatment in two groups: There was no significant difference in BMD before and after treatment in two groups (P ＞ 0.05).CONCLUSION: Compared with simple western drug treatment, the integrative therapy of point injection and electric acupuncture improves very significantly BMD of lumbar vertebras, aiming at effective treatment of primary osteoporosis. But the change in BMD of femur is not obvious before and after treatment, which is probably associated with lack of adequate blood circulatiou in femoral region.

Objective To compare the value of color Doppler echocardiography in the diagnosis of coarctation of the aorta (COA) in comparison with CT angiography (CTA). Methods Ninety-two patients with COA were retrospectively analyzed that were confirmed by surgery from January 2009 to September 2013 and diagnosed by color Doppler echocardiography and CTA. Results Among 92 COA patients conifrmed by surgery, 87 patients were diagnosed correctly by echocardiography while 91 patients were diagnosed by CTA, and the accuracy of echocardiography and CTA were 95%(87/92) and 99%(91/92), respectively without significant difference (χ2=1.550, P=0.213). According to surgical findings, there were 222 anatomic abnormalities including 110 intra-cardiac, 13 heart-vessel connection and 99 vessel abnormalities. For 110 intra-cardiac abnormalities, echocardiography detected all abnormalities while CTA found 92 with 18 missed including 11 valve or valve ring lesions, 3 patent foramen ovale, 2 atrial septal defect, 1 ventricular septal defect and 1 endocardial cushion defect. The accuracy of echocardiography for intra-cardiac abnormalities was signiifcantly higher than that of CTA (100%, 110/110 vs 84%, 92/110,χ2=18.801, P=0.000). CTA and echocardiography detected all abnormalities of heart-vessel connection. For 99 vessel abnormalities, CTA showed an accuracy of 98%(97/99) with 2 missed lesions including 1 collateral circulation between the aorta and the pulmonary artery and 1 membranous narrow of the aorta, while echocardiography misdiagnosed 1 COA as interruption of aortic arch and missed 15 lesions, including 4 COA, 3 collateral arteries, 2 patent ductus arteriosus, 2 aberrant right subclavian artery, 2 brachiocephalic vein abnormality, 1 partial anomalous pulmonary venous drainage and 1 persistent left superior vena cava. The accuracy of CTA for detection of vessel abnormalities was signiifcantly higher than that of echocardiography (98%, 97/99 vs 84%, 83/99,χ2=11.350, P=0.000). Conclusions Both CTA and echocardiography are effective diagnostic modalities for COA and CTA is superior to echocardiography for detecting vessel anomalies whereas echocardiography is superior to CTA for detecting intra-cardiac abnormalities. The combination of both modalities will provide more accurate information for clinical diagnosis.

Objective To evaluate the feasibility and application of histopathology diagnosis of endometrial tissues obtained by endometrial cell collector (Jingyou, SAP-1). Methods One hundred and ninety-three patients whose endometrial lesions should be excluded were selected. First, endometrial tissue were obtained from the patients by Jingyou, then they underwent comprehensive curettage under hysteroscopy. The histopathology diagnosis was performed respectively. The specimen satisfaction rate and diagnostic accuracy was analyzed and compared. Results The specimen satisfaction rate of curettage under hysteroscopy was 95.85%(185/193). The specimens of 8 cases were not satisfied because the tissues were not enough. The specimen satisfaction rate of Jingyou was 82.38% (159/193). The specimens of 34 cases were not satisfied, among whom in 10 cases scratches did not throughout the whole palace antrum, and in 24 cases tissues quality were poor. The endometrial thickness in unsatisfactory specimen by Jinyou was significantly thinner than that in satisfactory specimen:(0.64 ± 0.18) cm vs. (0.97 ± 0.43) cm, and there was statistical difference (P<0.05). The diagnostic accordance rate between Jingyou and curettage under hysteroscopy was 79.87%(127/159). The sensitivity of Jingyou from high to low was 94.19% (81/86) in normal menstrual endometrial, 7/10 in endometrial carcinoma/ atypical hyperplasia, 67.86%(38/56) in endometrial hyperplasia and 1/7 in endometrial polyps. Missed diagnosis of jingyou inluded 2 cases of endometrial carcinoma and 4 cases of endometrial atypical hyperplasia. The misdiagnosed rate of high grade endometrial lesions was 6/16, and the patients were misdiagnosed because the tissues were not enough. Four cases of endometrial atypical hyperplasia had underwent conservative treatment of repeated curettage. Conclusions Application of Jingyou can obtain micro endometrial tissues, and the accordance rate of histopathology diagnosis is high with curettage under hysteroscopy. When the collector makes a comprehensive collection to the uterine cavity specimen, it can accurately screen endometrial carcinoma and atypical hyperplasia. The patients who have endometrial atypical hyperplasia and receive conservative treatment and curettage repeatedly curettage, thin endometrium and ultrasonic highly suspected endometrial polyps, are not recommend to use Jingyou to obtain specimen. When the specimen is not satisfied using the collector, additional hysteroscopy should be performed to avoid misdiagnosis of high grade endometrial lesions.