Background Proliferative diabetic retinopathy (PDR) is a serious complication of diabetes mellitus,and vitrectomy is a main treatment.Exploring the influential factors of blood glucose fluctuation during perioperative duration is helpful for surgery.Objective The aim of this study was to explore glycolic fluctuation and its influential factors in PDR patients.Methods A retrospective cases-observational study was carried out.The clinical data of 100 PDR patients who received vitrectomy in Peking University People's Hospital from March to August in 2013 were collected,including 8 cases with type 1 diabetes mellitus and 92 cases with type 2 diabetes mellitus.The PDR patients were staged as Ⅳ,Ⅴ,Ⅵ based on the criteria of The First National Fudus Conference.The body height,weight,history of hypertension,PDR stage,previous usage of insulin,glycosylated hemoglobin (HbA1c) level,admission blood pressure,blood glucose level in different time points and postoperative body positions were recorded,and perioperative anxiety was scored according to the Hamilton Anxiety Scale (HAMA).Repeated ANOVA was used to analyze blood glucose and anxiety at different time points.Results The linear regression analysis showed that the preoperative blood glucose level was lower in the patients who used insulin during perioperative period(r =-1.64,P＜0.05).HbA1 c level showed the positive correlations with the blood glucose level at different time points(all at P＜0.05).The waiting time for surgery had a positive correlation with the fasting blood glucose in the morning of operative day(r=0.54,P＜0.05),and the postoperative position primarily caused the raise of postoperative right blood glucose(r =1.10,P＜0.05).The anxiety score on admission presented with the positive correlations with the blood glucose levels at admission and 2 hours after breakfast,lunch and dinner on the first postoperative day (r=0.13,0.07,0.05,0.10,all at P ＜ 0.05),and the high anxiety scores at preoperation and postoperation induced the high blood glucose levels at the corresponding time points (r =0.14,0.16,both at P＜0.05).A positive correlation was found between the anxiety score and blood glucose fluctuation values (ρ=0.47,P＜0.01).The blood glucose values were significantly lower in the patients with normal HbA1c than those with high HbA1c (all at P ＜ 0.05).Conclusions Remaining an ideal HbA1c level,establishing a good doctor-patient relationship and administering appropriate sedative drugs can ease the anxiety and improve the glycolic of PDR patients during preoperative duration.

The paper uses computer multimedia technology to collect and switch audio and video signals, constructs the remote High Definition ( HD) surgery demonstration system which supports live broadcast, recorded broadcast, rebroadcast and video-on-demand depending on the network communication routing technology.It introduces functions, design scheme and composition of the system and points out that the system can realize HD video transmission and video talkback between the surgery scene and the classroom.Thus, tech-nical level of clinical surgery teaching can be enhanced.

ObjectiveTo explore the relationship between the expression of Dishevelled2 and Vangl2 and the embryonic neural tube defects (NTDs) induced by all-trans retinoic acid (RA)in Kunming mouse. Methods Fifty pregnant mice were randomly divided into control and RA-treated groups.RA-treated mice were fed with 30mg/kg RA dissolved with peanut oil on embryo 7.75 days, while the mice of control group were administrated with an equal volume of peanut oil on the same time. Then all the embryos were sampled from pregnant mice at the 4th, 18th, 42nd, 66th and 90th hour after treatment. In situ hybridization and immunohistochemical staining technique were used to detect the expression of Dishevelled2 and Vangl2 in embryonic neural tube. Results The two proteins both existed in the epithelial tissue of the mouse embryonic neural tube and displayed different expression modes at various developmental stages.Compared with the control group, the RA treated group showed a significant decrease (P≤0.05) at the 18th and 42nd hour and a significant increase (P≤0.05) at the 66th hour in Dishevelled2 protein after maternal treatment, and no significant difference was found at the 90th hour. Compared with the control group, the Vangl2 mRNA expression in the RA treated group displayed a significant decrease (P≤0.05) at the 4th and 18th hour and a significant increase (P≤0.05) at the 66th hour after RA treatment, and no difference was found at the 42nd hour. Compared with the control group, the expression of Vangl2 protein in the RA treated group decreased (P≤0.05) at the 18th and 42nd hour, and increased (P≤0.05) at the 90th hour after RA treatment, no difference was found at the 66th hour. Conclusion Excessive RA may interfere with the normal embryonic neural tube closure by regulating the expression of Dishevelled2 and Vangl2.

Objective The relationship between fever and the recent curative effect of transcatheter arte -rial chemoembolization ( TACE) and the related factors of fever after transcatheter arterial chemoembolization in large hepatocellular carcinoma is discussed in this paper .Methods One hundred and twenty patients with large liver cancer were divided into two groups according to the fever after TACE .The fever in group A ,and there was no fever in group B after TACE .The changes of the lesions in the two groups were compared after the first inter-ventional treatment .The factors affecting the fever after TACE were analyzed .Results The CT was performed at about one and half month after the first intervention .The curative effects of A and B were evaluated by RECIST criteria.Two groups of CR,PR,SD,PD were 0,11.11%,71.11%,17.78%and 0,0,33.33%,66.67%,respec-tively.The difference of the efficiency of OR was statistically significant (P=0.049).The probability of fever of four types of iodine oil deposits are as follows:100%,93.33%,81.93%,0.Blood supply type,middle and severe hepatic arteriovenous fistula,the use of gelatin sponge,tumor necrosis,and the use of iodine oil were more than 25ml may be factors affecting postoperative fever .Conclusion The clinical symptoms of fever after TACE sug-gest that the lesion is well embolization and iodine oil deposit is good ,and the lesion is not easy to progress ,and short-term curative effect is better .The analysis of the factors that affect the postoperative fever may help to eval-uate the curative effect of patients with large hepatocellular carcinoma .

Neuroglobin is a newly discovered member of globulin family.It has neuronprotec- tive effect under the hypoxic and ischemic conditions.In order to make the acting mechanism of globulin clear,many theories have been raised,and corresponding experiments have been done. This article reviews the latest advances systematically in this field,and puts forward possible research directions in the future.

Objective To evaluate the diagnosis and treatment of residual gallbladder.Methods The diagnosis of residual gallbladder depends on a history of previous cholecystectomy and postoperative existent symptoms suggesting cholecystitis.In this series the diagnosis was finally established by ultrasonography and laparotomy in 52 cases.Results Ten cases received laparoscopic residual cholecystectomy,32 cases underwent residual cholecystectomy,7 cases did residual cholecystectomy plus common bile duct exploration,1 case was treated with residual cholecystectomy,common bile duct exploration and left lateral lobe hepatectomy,1 case with residual cholecystectomy,common bile duct exploration,cholangioenterostomy,1 case by radical resection of residual gallbladder cancer.Conclusions Residual gallbladder is a secondary disease,diagnosis is not difficult,surgery has certain difficulty,the application of intraoperative ultrasound and choledochoscope has great value.

Objective To evaluate effects of two different preoperative biliary drainages on patients of malignant obstructive jaundice complicated with acute cholangitis.Methods Retrospective analysis was made on effects of two preoperative biliary drainages of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) and endoscopic nasobiliary drainage (ENBD) in cases of malignant obstructive jaundice complicated with acute cholangitis.Results Days of preoperative drainage(t =3.217,P ＜ 0.05) and declines of bilirubin level after drainage (t =3.178,P ＜ 0.05) were significantly better in ENBD group (26 cases) than PTCD group (22 cases).There were no significant differences between two groups in operation time length and intraoperative blood loss after drainage.However,postoperative hospital stay (t =2.542,P ＜ 0.05) and overall stay (t =3.172,P ＜ 0.05) were significantly shorter in ENBD group compared with PTCD group.Conclusions When preoperative biliary drainage is indicated in the cases of malignant jaundice before radical surgery,ENBD should be the first choice over DTCD.

Objective To study the effect of percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) in treatment of acute severe cholecystitis.Method The perioperative data of patients treated with PTGBD combined with LC and patients treated with emergency LC were analyzed.Results There were no significant difference between the two groups on surgical duration (t =0.601,P =0.551) and postoperative hospital stay (t =0.979,P =0.331).Blood loss [PTGBD + LC (79.43 ± 46.27) ml,LC (125.84 ± 64.18) ml ; t =3.641,P ＜ 0.05],peritoneal drainage time [PTGDB + LC (3.29 ± 1.58) d,LC (4.63 ± 2.31) d ; t =3.131,P ＜ 0.05] and postoperative oral intake time [PTGBD +LC (2.91 ±1.58)d,LC (4.21 ±2.22)d; t =2.669,P＜0.05] were significantly different between the two groups.The rate of laparotomy,mortality and postoperative complications in the emergency LC group were higher than those in the PTGBD combined with LC group.Conclusions PTGBD combined with LC in the treatment of acute severe cholecystitis was significantly better than emergency LC.

Background and purpose: Astrocytoma is the most common neuroepithelial neoplasm, and its grading has profound effect on its treatment and prognosis. To investigate the application of stepwise discriminant analysis in grading astrocytomas, this study developed two models of stepwise discriminant analysis according to relevant factors of astrocytoma. Methods: From January 2008 to April 2009, 111 primary astrocytoma patients were enrolled. Each patient was scored based on location, signal intensity on T1WI, signal intensity on T2WI, enhancement, edema, border, cyst or solidness, and mass effect of their magnetic resonance images. With their age score of grading, Fisher stepwise discriminant analysis and the Logistic discdminant were used. The results from the two models were then evaluated and compared. Results: According to Fisher stepwise diseriminant analysis, the predictive accuracy was 87.7% with 80.0% sensitivity, 91.5% specificity and 0.942 area of ROC curve. However, the predictive accuracy of Logistic discriminant analysis was 84.9% with 80.0% sensitivity, 86.8% specificity and 0.940 area of ROC curve. There were no statistically significant differences in terms of accuracy (P=0.250) and areas under ROC curve (Z=0.433, P=0.665) between the two models. Conclusion: Two stepwise discriminant analysis models are meaningful to predict the grading of astrocytoms, and the application of Fisher stepwise discriminant analysis is simpler than the Logistic discriminant analysis.

Objective To investigate the effect of apolipoprotein E gene knock-out(ApoE KO) and high-fat diet on morphology and the expression of mortalin in hippocampal CA_3 neurons of mice, and to explore the impact of these factors on memory and Alzheimer's disease.Methods Ten wild-type and 10 ApoE KO mice were fed with common chow as the control group and the KO group respectively while 10 ApoE KO mice were fed with high fat diet.Twelve weeks later, the weight and the lid of these mice were measured.The brain tissues were observed using HE staining, nissl staining, protargol staining,immunohistochemistry staining and image analysis by computer.Results In the ApoE KO group, weight,total cholesterol, triglyceride, low-density lipoprotein cholesterol were higher than those in the control group,and these changes were more significant in ApoE KO high-fat diet group.The nissl was higher in the ApoE KO group (0.301±0.031) and in ApoE KO high-fat diet group (0.261±0.020) than those in the control group (0.341±0.035, F=18.068, P<0.05).The mortalin in the ApoE KO group (0.322±0.060) and in ApoE KO high-fat diet group (0.391±0.041) were higher than the control group (0.256±0.061, F=15.230, P < 0.05).Conclusions ApoE KO and high-fat diet can reduce nissl, and improve the expression of mortalin.This protein may be involved in the pathogenesis of Alzheimer's disease.