AIM:To study the efficacy and safety of intravitreal injection ranibizumab (IVR) assisted 25G+ minimally invasive vitreoretinal surgery (VRS) in the treatment of severe proliferative diabetic retinopathy (PDR).METHODS: Totally 61 patients and 74 eyes were selected with severe PDR from March 2015 to June 2016 in our hospital.According to the principle of voluntary,37 eyes of 31 cases in the VRS before the IVR treatment was set to the joint group,37 eyes of 30 cases line pure VRS was set to the VRS group.We compared the vitreous volume,logMAR,mean IOP,macular central retinal thickness and complications between the 2 groups.RESULTS: The blood rate of glass in the combination group was 8% after 1wk of postoperative which was significantly lower than that of the VRS group 27% (x2=4.573,P=0.032).The glass volume blood rate of the combined group was 0 after 1mo of postoperative while the VRS was 16%(P=0.033).The blood rate of glass in the combination group was 0 at 3mo of postoperative,and 8% in the VRS group(P=0.238).The LogMAR in the combined group was significantly lower than that in the VRS group(t=2.320,P=0.023).There was no significant difference in the mean IOP between the two groups (t=0.516,P=0.608).The mean macular retinal thickness of the combined group was 298.8±78.3μm which significantly lower than the VRS group 357.1±86.2μm(t=3.045,P=0.003).The combined high ntraocular pressure rate of the combined group was 14% which was significantly lower than 32% of the control group(x2=10.385,P=0.001).The rate of anterior membrane of the retina of the combined group,the rate of recurrent traction and the rate of retinal detachment of the newborn were lower than that of the VRS group,but the difference was not statistically significant (P>0.05).CONCLUSION: IVR assisted VRS,although there is a certain controversy,but in the appropriate dose,frequency and time to achieve significant efficacy,safety is also high.

Objective To explore the methods and effects of the general resident nurse on duty system,and thereby to play an effective role of skilled nurses to ensure the quality and safety of nursing.Methods Using the management experience of general resident doctors for reference,a general resident nurse on duty system was established.The general resident nurses were strictly selected,trained and examined.At the same time,the management regulations were formulated.Results This practice cultivated a general resident nurse team with well-prepared nursing knowledge,skilled techniques,good capacity to cope with emergency,which could play important roles in the guidance and quality control of clinical nursing.Conclusion The implementation of general resident nurse on duty system can help train the backbone of specialized care,reserve the force of handling emergency and improve the quality of nursing.

Objective To evaluate the efficacy of 3+x mode for the reduction of unplanned extubation in the patients with stomach cancer. Methods 107 patients with the indwelling gastric tube of gastric cancer perioperative from June 2014 to September 2014 were collected as the observation group, and 101 patients with the indwelling gastric tube of gastric cancer perioperative from June 2013 to September 2013 were collected as the control group. Once preoperative education on stomach tube was performed in the control group, and 3+x education mode was used in the observation group, so as to compare unplanned extubation rate of two groups. Results The tube unscheduled decannulation rate in postoperative patients with gastric cancer in the control group was significantly higher than that in the observation group [4.95 %(5/101) vs 0 (0/107)], and there was significant difference (χ2= 5.168, P= 0.029). Conclusion 3+x mode education can significantly reduce unplanned extubation rate in operation patients with gastric cancer.

OBJECTIVE: To evaluate the influence of endoscopic sinus surgery on olfactory disorder caused by chronic sinusitis and nasal polyps, by testing the olfactory function of seventy-four patients before and after endoscopic sinus surgery,and evaluate the outcomes of olfactory dysfunction after endoscopic sinus surgery in patients with choinc rhinosinusitis and the related factors. METHOD: The olfactory function of the seventy-four patients with chronic sinusitis and nasal polyps were tested by the T&T olfactory testing method at pre-operation and four weeks,twelve weeks, twenty-four weeks of post-operation. Patients were divided into two groups, according to whether combined with allergic rhinitis. Data were achieved by the scores of endoscopic appearances of Kennedy, and CT staging system of Lund-Mackey. Parallel processing standard endoscopic operation and processing specification during peri operation period. Analysing the degree of olfactory rehabilitation in chronic sinusitis and nasal polyps with allergic rhinitis. RESULT: (1) Compared with the level of olfactory function, significant improvement was found at first month;however, the olfactory function level 4 weeks after operations was significantly statistically different with that 12 weeks and 24 weeks after operations; (2) Lund-Mackey sinus CT higher score is related to the worse degree of postoperative nasal olfactory rehabilitation (P < 0.05). (3) The higher scores of endoscopic appearances of Kennedy is related to the worse degree of postoperative nasal olfactory rehabilitation (P < 0.05). (4) Allergic rhinitis is one of the factors of olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation, the olfactory rehabilitation of patients with allergic rhinitis is worse than that in the patients with no allergic rhinitis. (5) Course of disease is one of the factors of chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation. Longer the course of disease, worse the olfactory rehabilitation. (6) E osinophil count was related to olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation. Higher Eosinophil count, worse the olfactory rehabilitation. CONCLUSION FESS plays a positive role in the improvement of olfactory impairment in patients with CRS. It is important to protect the olfactory mucous during surgical removal of sinonasal lesions. The standard intraoperative procedure, treatment on allergic rhinitis and regular follow-up after operation are also very important.
Chronic Disease ; Endoscopy ; Humans ; Nasal Polyps ; complications ; surgery ; Nasal Surgical Procedures ; Olfaction Disorders ; rehabilitation ; Paranasal Sinuses ; surgery ; Postoperative Period ; Rhinitis, Allergic ; complications ; Sinusitis ; complications ; surgery ; Smell

Objective: To develop the ultra performance liquid chromatography tandem mass spectrometry ( UPLC-MS/MS ) for the determination of perfluorocarboxylic acids ( PFCAs ) in fish. Methods: The fish samples were extracted with tert-butyl methyl ether and purified by WAX columns. The WAX cartridges were rinsed with methanol and 25 mmol/L ammonium acetate, and the target compound residues were eluted with 0.5% ammonia methanol and then redissolved with 50% methanol aqueous solution after nitrogen blowing to nearly dry. Nine kinds of PFCAs were simultaneously quantified by UPLC-MS/MS with 1 mmol/L ammonium acetate-methanol solution as the mobile phase. Results: The extraction was separated well in UPLC BEH C18 column. There were good linear correlations of nine kinds of PFCAs in the range of 1.0-200.0 ng/mL, with the coefficients all more than 0.99. The limits of detection and quantification were 0.06-0.19 μg/kg and 0.19-0.62 μg/kg, respectively. The recovery rates were 70.08%-117.24% at different spiked levels ( 5.0, 25.0, 50.0 μg/kg ), and the relative standard deviations were 2.31%-19.68%. Conclusion Through optimizing the pretreatment conditions, the mobile phase of liquid chromatography and the detection conditions of mass spectrometry, the UPLC-MS/MS could meet the monitoring requirements of PFCAs in fish.

ObjectiveTo investigate the clinical features of patients with painless acute pancreatitis ( AP),and to improve the diagnosis accuracy of painless AP.MethodsThe clinical data of 12 patients with painless AP were retrospectively collected from January 2007 to January 2011.Results The mean age of patients with painless AP was 52 years old.Seven (58.3％) patients complained of abdominal distension and discomfort,4 (33.3％) patients complained of nausea and vomiting,abdominal tenderness occurred in 7(58.3％ ) patients.Serum levels of lipase and amylase was increased in 11 (91.7％) and 8 (66.7％)patients,respectively.The diagnostic accuracy of abdominal ultrasound and CT for AP was 58.3％ and 91.7％,respectively.Five (41.7％) patients were diagnosed to have AP upon admission,and 4 patients were misdiagnosed to have non-digestive diseases.There were 7 severe AP patients among the 12 painless AP patients,and the percentage was significantly higher than that in AP patients with pain (65/327,x2 =7.30,P ＜ 0.05).Painless AP patients needed longer hospital stay when compared with that of AP patients with pain [ ( 20.4 ± 9.1 ) d vs.( 12.9 ± 6.2) d,t =2.296,P ＜ 0.05 ) ].ConclusionsThe misdiagnosis rate of painless AP is high and patients with painless AP are in critical situation,and early measurement of serum levels of lipase and amylase,as well as CT scan is important for correct diagnosis.

A questionnaire survey was conducted among 319 mental health workers from 319 grassroots health institutions of 21 districts (cities,counties) in Chengdu in March 2013.The items of survey included general information of participants,subjective perceptions and status of community mental health services.Total 252 effective questionnaires were received,the average age of participants was (33.12 ± 9.39) years (19-61);59.5％ had clinical medicine and 16.3％ had public health background;most of them had educational levels of three-year college or below (84.9％);the average duration of working experience was 18 months;86.5％ was part-time;most of participants (87.4％) thought that the mental health service was a hard job and only 25.3％ expressed satisfaction with the work.Only 16.3％ of community health service centers had rehabilitation facilities for mental illness patients.Public health education was carried out for average (2.21 ± 1.62) times/year,the education for mental patients and family members was (1.62 ± 1.83) times/year.Between areas with sufficient detection rate of mental illness and those with insufficient detection rate,there was significant difference in training frequency of mental workers (P =0.012),there were no significant differences in having formal employment of mental workers (P =0.064),professional guidance,co-working with police officers,co-working with Disabled Persons' Federation,and the duration of working experience (all P ＞ 0.05).The results suggest that the capacity of mental health service in community levels is relatively weak in Chengdu,and the personnel training,public education and rehabilitation work of mental health need to be strengthened.

This study was aimed to explore the mechanism of baicalin on high altitude cerebral hypoxia-ischemia on mice and its influence on related target protein expressions. Morris water maze was used to screen 50 Kunming mice, which were randomly divided into the model group, control group, the low dose (0.05 mg·kg-1), middle dose (0.20 mg·kg-1) and high dose (0.60 mg·kg-1) baicalin group, with 10 rats in each group. The space memory and learning ability of mice were tested. The animal cabin with low oxygen (simulating at 4 000 m altitude) was used to establish the stable high altitude cerebral hypoxia-ischemia mouse model. Changes on SOD content, GSH-PX activities and MDA content in hippocampal tissues of mice were detected. The expressions of different target proteins, including cleaved-caspase 3, P-AKT, GFAP, Bax and Bcl-2 in brain stem of mice were detected by western blot. The results showed that the latent period of the model group was obviously longer than that of the control group (P < 0.05). The latent period of high dose baicalin group was shorter than the model group with significant difference (P< 0.05). Therefore, the best effective dose of baicalin was 0.60 mg·kg-1. Compared with the control group, the content of MDA in the hippocampal tissues of mice in the model group was significantly increased; the SOD and GSH-PX activity were obviously reduced (P < 0.05). Compared with the model group, the SOD and GSH-PX activity were obviously increased in the brain tissues of mice in the high dose baicalin group; and the content of MDA was obviously reduced (P < 0.05). From the level of protein changes, the stripes of cleaved-caspase 3, P-AKT, GFAP protein expressions in the model group were strengthened compared to the control group; the ratio of Bax/Bcl-2 was also obviously increased (P < 0.05). The expression of the baicalin group was lower than that of the model group (P < 0.05). Among them, the expression of the high dose baicalin group was the lowest. It had certain dose-response relationship. It was concluded that baicalin had protective effect on high altitude cerebral hypoxia-ischemia. Its mechanism may be related to its powerful oxidation resistance and its inhibition on expression of different target proteins, including cleaved-caspase 3, P-AKT, GFAP, Bax, Bcl-2 for the change of apoptotic pathway.

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 explore assessment value of heart rate variability (HRV) of Holter for cardiac autonomic nervous function in patients with acute stroke.Methods: A total of 80 cases with acute stroke treated in our hospital were regarded as stroke group, and another 80 inpatients without cardio-and cerebrovascular diseases were enrolled as control group simultaneously.Holter was used to perform 24h ambulatory heart rate monitoring on two groups, and the results were compared between two groups.Results: Compared with control group, there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period [SDNN, (129.89±5.42) ms vs.(92.58±4.36) ms], standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording [SDANN, (118.85±5.79) ms vs.(77.36±4.82) ms], root-mean square of differences between successive normal to normal intervals [rMSSD, (27.04±1.18) ms vs.(7.31±1.09) ms] and adjacent normal RR interval difference >50ms stroke accounted for a percentage of 24h total RR interval [PNN50, (8.97±1.48)% vs.(2.62±0.54)%] in stroke group, P<0.01 all;in stroke patients, there were no significant difference in above indexes between cerebral infarction patients and cerebral hemorrhage patients, P>0.05 all.Conclusion: HRV indexes possess significant assessment value for cardiac autonomic nervous function in patients with acute stroke.They can predict patient′s status changes, and help to prevent and identify severe cerebrovascular disease in time.