AIM: To evaluate the use of 23G minimally invasive vitreous cutting system in the first stage of anterior segment reconstruction on severe ocular injury.
METHODS: Fifteen patients with ocular injuries including the corneal and scleral rupture associated hyphema, vitreous hernia in anterior chamber, traumatic lens rupture, lens subluxation, applied 23G minimally invasive vitreous cutting system in the first stage of anterior segment reconstruction.
RESULTS: The anterior ocular media of early postoperative became transparent quickly. No exudative lemma and no complications were found relate to puncture incisions after operations.
CONCLUSION:23G minimally invasive vitreous cutting system can be used in the first stage of anterior segment reconstruction on sever ocular injury. It can reduce iatrogenic injury, operative complications and inflammatory response, also can shorten therapeutic time and create favorable conditions.

Adolescent ; Adult ; Audiometry, Pure-Tone ; Ear Protective Devices ; utilization ; Humans ; Middle Aged ; Noise, Occupational ; prevention & control ; Young Adult

Objective To investigate the value of drug intervention for difficult weaning from mechanical ventilation. Methods A prospective single-blind randomized controlled trial was conducted. 120 patients with difficult weaning from mechanical ventilation encountered in Department of Critical Care Medicine of Peking University Third Hospital from January 2008 to December 2013 were included,and the patients were divided into treatment group and control group according to random number table,with 60 cases in each group. Patients received furosemide therapy in the treatment group 3 days before weaning up to 48 hours after weaning in order to control negative liquid balance. Enema was given the day before weaning to reduce abdominal pressure. On the weaning day,all of the patients received nitroglycerin and beta blocker or cedilanid to prevent or control elevation of blood pressure and heart rate in the process of weaning. All patients in treatment group received anisodamine in small dosage 2 hours before extubation.The patients in control group received conventional treatment without drug intervention. Baseline indexes of two groups were compared,including the heart rate,respiration rate(RR),mean arterial pressure(MAP),pulse blood oxygen saturation(SpO2),blood gas,hemoglobin(HG),albumin(ALB)and creatinine(Cr). The main reasons of difficulty in weaning,sedative and analgesic drug selection,presence of abdominal discomfort before weaning,interval between sputum suction before extubation,liquid balance at the beginning of the investigation and at time of weaning,24 hours and 48 hours after weaning,failures of spontaneous breathing test(SBT),length of mechanical ventilation,length of ICU stay,and total length of mechanical ventilation and total length of ICU stay during hospitalization. Results There was no statistically significant difference in the heart rate,RR,MAP,SpO2,blood gas,HG,ALB,Cr at the beginning of the investigation between the two groups. The main reasons for difficult weaning in both groups of patients were respiratory dysfunction,cardiac insufficiency,and central nervous system dysfunction. The use of propofol combined dexmedetomidine in the treatment group was more frequent than the control group〔16.7%(10/60)vs. 1.7%(1/60),χ2=8.107,P=0.004〕,and there was no statistically significant difference in the use of other combinations of sedative drugs between the two groups. Abdominal discomfort before weaning was milder in treatment group as compared with control group〔10.0%(6/60)vs. 25.0%(15/60),χ2=4.675,P=0.031〕. The interval between sputum suction before extubation in the treatment group was significantly longer than that of the control group〔hours:1(1,2)vs. 1(1,1),Z=-2.209,P= 0.027〕. SBT failure was less frequent in treatment group compared with control group〔times:0(0,1)vs. 1(1,2),Z=-6.561,P=0.000〕. Liquid balance was better in the treatment group than the control group at time of weaning,24 hours and 48 hours after weaning〔at time of weaning:-567.71 (-755.95,-226.41)vs. 1 256.76(472.48,1 796.63),Z=-9.038,P=0.000;24 hours after weaning:-5.03 (-530.28,245.09)vs. 342.28(125.36,613.25),Z=-4.711,P=0.000;48 hours after weaning:115.50(-450.26, 485.00)vs. 330.00(16.25,575.25),Z=-1.932,P=0.053〕. Compared with control group,length of mechanical ventilation〔days:1.0(1.0,2.0)vs. 2.0(2.0,3.0),Z=-6.545,P=0.000〕,ICU stay time〔days:3.0(3.0,4.0) vs. 4.0(4.0,5.0),Z=-6.545,P=0.000〕,and total length of mechanical ventilation〔days:8.0(6.0,12.0)vs. 11.0(8.0,15.0),Z=-4.091,P=0.000〕and total length of ICU stay during hospitalization〔days:12.5(9.2,19.0) vs. 17.0(12.0,29.5),Z=-2.722,P=0.000〕were all significantly shorter in the treatment group. Conclusions Adjuvant drugs therapy is helpful in patients weaning from the mechanical ventilation,and can shorten length of mechanical ventilation and ICU stay time. Propofol,combined dexmedetomidine,is helpful for weaning.

Objective To examine among preschool children the validity, reliability and sensitivity of a new assessment tool of Mandarin sentence recognition in babble noise, consisting of twenty-seven equivalent lists, as well as to investigate the effect of age and gender on children's speech recognition. Methods Fifty-four normalhearing children aged 4 to 6 years were recruited from Beijing and were divided into three age groups (4～, 4.5～,and 5.0～6.0 years) containing 18 children each, half boys and half girls. According to randomized split-plot design, we examined their speech recognition ability with 27 sentence-in-babble-noise lists in a sound-treated booth in a kindergarten (ambient noise ＜40 dB). The sentences were presented at fixed intensity of 65 dB SPL, paired with competing babble noise at three different signal to noise ratios (SNR= +1, -2, -5 dB) by the same loudspeaker with 0° azimuth. Speech recognition score were calculated based on the children's repetition of keySNR functions exhibited that the threshold was -1.96±0. 19 dB SNR and the slope was 15.8%±1.1%/dB for of variance and Post- Hoc Scheffe test indicated that significant differences in performance were most pronounced between the 4～ year group and the other two groups (P＜0.001), while there was no significant difference between 4.5～ year group and 5.0～6. 0 year group (P=0. 90). The girls' performance was also significantly better than boys' (P＜0. 001). Conclusion The 27 lists of Mandarin speech recognition in babble noise were equivalent among children, and the sensitivity of performance versus SNR was 15.8%/dB. Both of them were below the adult averchildren aged 4.5～ up years. Even though the performance differed between boys and girls, the difference was relatively small compared to 24.6%, the critical difference as the reliability indicator.

Objective To investigate the expression pattern of carbonic anhydrase 1 (CA1) in different clinical stages of color ectal cancers and the correlation between CA1 expression and pathologic characteristics of colorectal cancer.Methods The expression of CA1 in genetic level was detected by real-time quantitative polymerase chain reaction (PCR) and the expression of CA1 in protein level was detected by Western blot and immunohistochemical staining.Results The expression pattern of CA1 in the protein level was very similar to the genetic level.It had a very low expression level in carcinoma tissue,especially at stages Ⅲ and Ⅳ (P ＜0.01),CA1 had significantly lower expression level in the colorectal patients with metastasis (P ＜0.01).CA1 was gradually decreased from well-differentiation tissue to poorly-differentiation tissue with a significant difference between well-differentiated adenocarcinoma and poorly-differentiated adenocarcinoma (P ＜ 0.01).Kaplan-Meier survival analysis showed that the expression of CA1 was extremely related to colorectal carcinoma (CRC) prognosis.The 5-year survival rate was only 8％ in the CA1 negative expression group,and the 5-year survival rate of the patients with CA1 positive expression was 92.86％ (P ＜ 0.01).Conclusions CA1 had the similar expression patterns at genetic and protein levels.In the colorectal cancer tissue,the expression of CA1 was downregulated and even missing.CA1 had significantly lower expression level in the advanced colorectal cancers with metastasis and poorly differentiated colorectal cancer tissues.The patients with lower CA1 expression level had the worse prognosis.

Objective To find out the factors which would be likely to affect the occurrence of lactation mastitis.Methods 216 patients with lactation mastitis,who met our grouping criteria,were chosen for survey and clinical data collection.Their age,time of onset,mode of delivery,post-partum colostrum time,mastering of breast-feeding skills,feeding habits,occurring site of their mastitis and other data were input into SPSS 17.0 software,respectively,to perform retrospective analysis.Results Patients' average age and their age of first breast-feeding were all 30 years old ; the average age of their first pregnancy were 27 years old.Their initial post-natal breast-feeding was about 2 to 4 days.The onset of incidence of mastitis was about 28 days post-natal.First,second and third pregnancy patients represented 1/3 of the total patients respectively.63.4％ patients had cesarean delivery and only 36.6％ patients had vaginal delivery; 91.7％ were outpatients and 8.3％ patients were inpatients.10.6％ patients had abscess and 89.4％ patients hadn't.The distribution ratio of inflammation in the upper outer,lower outer,lower inner and upper inner quadrants of the breast was 30.6％,48.1％,19％,2.3％ respectively.If the mode of delivery is considered as a factor to investigate incidence time of mastitis and postpartum colostrums time,no significant difference between the two groups was found (P ＞ 0.05).Our survey indicated that 79.2％ patients did not have any knowledge of breastfeeding,8.8％ patients got the breast-feeding knowledge from their mothers,11.6％ patients got the breastfeeding knowledge from books or web resources,only 0.5％ of the patients participated in the training of breast-feeding.76.9％ patients never had breast massage,19％ of patients had a few times of massage,2.8％ of patients had occasional massage,and only 1.4％ of patients had regular breast massage with the help of their family.85.6％ patients didn't have their breasts emptied from breast-feeding to incidence of mastitis,11.6％ patients occasionally emptied their breasts,and only 2.8％ of patients can ensure one side of the breasts emptied daily.56.5％ patients used lying position with the lower breast as the most common breastfeeding posture,37％ patients used sitting position,only 6.5％ of patients used lying position with the upper breast.The correlation analysis of breeding posture and occurring site of lactation mastitis revealed that the Spearman coefficient was-0.14,P value was 0.04,which is statistically significant,suggesting there is correlation between occurring sites of lactation mastitis and breeding posture.Conclusions Mothers need to master breast-feeding skills including breast massage,breast milk emptying and breast-feeding postures to prevent the occurrence of mastitis.Furthermore,gravity probably affects the occurring sites of mastitis through its impact on patients' preferred breast-feeding postures.

AlM: To explore the clinical significances and changes of related parameters of corneal endothelial cell in keratouveitis patients before and after treatment.
METHODS:Fifty-two keratouveitis patients ( 52 eyes ) diagnosed and treated in our hospital from October 2012 to December 2013 were collected. Before and after treatment, the related parameters of corneal endothelial cell in all patients were measured with non - contact corneal specular microscope and these parameters were statistically analyzed.
RESULTS: Compared with the normal group, obvious endothelial cell edema and great variation was observed in diseased group. The shorter duration of treatment, the better the recovery of endothelial cells and the fewer cells lose. Conversely, the longer the healing of normal hexagonal cell ratio was smaller, the larger the coefficient of variation. Before and after treatment, the differences of each parameter were statistical significance (P<0. 05).
CONCLUSlON: The functional recovery of corneal endothelial cell has directly relation with disease times.

Objective To discuss the effects of bacille calmette guerin(BCG) alone of combined with interferon gamma(IFN-?) and vitamin A in preventing asthma after bronchiolitis.Methods Fourty-four bronchiolitis infants(RBI) were treated with BCG alone or combined with vitamin A/IFN-?.Protein purified derivative(PPD) skin test were observed before and 3 months after interference and all infants enrolled in the study were followed up for average one year to observe the wheezing episodes. Ninteen cases of RBI without BCG treatment were control group.Results The average diameter of PPD skin test in RBI after BCG inoculation was significantly larger than that of before inoculation and control group(P

The purpose of this study is to prepare galactosyl modified lipid bilayer-coated mesoporous silica nanoparticles (GPEM) to enhance the antitumor efficacy against hepatocellular carcinoma cells. The irinotecan (CPT-11) loaded mesoporous silica nanoparticles (MSNs) was coated with the Gal-P123 modified functional lipid bilayer by thin-film dispersion method. Nanoparticles were characterized with particle size, zeta potential, morphology and drug release in vitro. Afterwards, the cell uptake, intracellular concentration of CPT-11, cell apoptosis rate and cytotoxicity were evaluated on human hepatocellular carcinoma cell line Huh-7. The results showed that MSNs were coated with intact lipid bilayers and the nanoparticles had clear core-shell structure. GPEM is stable with the mean particle size of (78.01 +/- 2.04) nm. The low leakage rate in normal physiological conditions in vitro is contributed to the protection of stable lipid bilayer, and the fast drug release in acid environment due to the destruction of the lipid bilayer. On the cell level, the vector could improve the intracellular CPT-11 concentration by 4 times because of the functional lipid bilayer. The high CPT-11 concentration led to the increasement of apoptosis rate by 48.6%, and the reduction of half maximal inhibitory concentration (IC50) values of CPT-11 by 2 times, indicating stronger cell cytotoxicity.