AIM: To analyze the reasons of low vision and blindness in elderly patients and the application of optical aids in rehabilitation.METHODS: Totally 87 elderly patients which had 74 cases of low vision,13 cases of blind,including 53 males and 34 females.Routine internal and external eye examinations should be performed,and special removal examinations should be performed if necessary.Both refractive correction,and try with far and near optical aids,check after wearing a typoscope distant and near vision,distant vision ≥0.05 out the blindness,distant vision ≥0.3 out the disability.Near vision ≥ 0.5 was valid,<0.5 was invalid.RESULTS: Among 87 elderly patients with low vision,high myopia was the leading cause of blindness,followed by macular degeneration,cataracts,glaucoma and diabetic retinopathy.The visual acuity after refractive correction increased ≥ 2 lines in 62 cases (71%),visual acuity was not correct or corrected for ≤ 1 of 25 cases (29%).With aids,far visual was ≥0.3 of the 70 cases (80%),≥0.05 in 10 cases (11%),<0.05 in 7 cases (8%),residue removal rate of 92%.With reading glasses near and near visual acuity was >0.5 effective in 60 cases (69%),<0.5 ineffective in 27 cases (31%).Typoscope was often used in 58 cases,not often used 18 cases,11 cases rarely used or give up.CONCLUSION: High myopia is the leading cause of low vision and blindness in the elderly,followed by macular degeneration.The application of visual aids is still reliable and economical and effective treatment method,patients should be encouraged to use visual aids to improve the utilization rate of aids,so as to improve the quality of life of patients.

OBJECTIVETo detect the clinical value of the ECT bone scan in evaluating of the situation of infection control after hip knee arthroplasty.

METHODSThe clinical data were retrospectively analyzed in 62 patients, including 34 males and 28 females with an average age of 68.8 years old ranging from 65 to 74 years. The results of ECT bone scan, erythrocyte sedimentation rate, C-reactive protein were used to assess periprosthetic infection. The patients with positive ECT and ESR on CRP were considered to have periprosthetic infection; however, the patients with two or more negative, indexes were considered to have no infection.

RESULTSThe sensitivity, specificity, accurate rate of ECT were 75.0%, 88.9%, 87.1% respectively; ESR 50.0%, 72.2%, 69.4%; CRP 62.5%, 81.4%, 79.0%. The combination of the three methods were 87.5%, 96.3% and 95.2%,

CONCLUSIONCompared with ESR and CRP, ECT is a more effective way in the diagnosis of periprosthetic infection, which has great value and is worth popularizing.

Aged ; Arthroplasty, Replacement ; adverse effects ; Blood Sedimentation ; Bone and Bones ; diagnostic imaging ; C-Reactive Protein ; analysis ; Female ; Humans ; Male ; Prosthesis-Related Infections ; diagnostic imaging ; Retrospective Studies ; Tomography, Emission-Computed ; methods

Objective To investigate the protective effects of propofol against acute lung injury(ALI) induced by oleic acid.Methods Forty adult male SD rats weighing 250-290 g were anesthetized with intraperitoneal(i.p.)20% urethrane 6 ml?kg~(-1) and tracheostomized.Left common carotid artery and right internal jugular vein were cannulated for BP monitoring and fluid and drug administration.The animals were randomly divided into 5 groups (n=8 each):Ⅰ control group;Ⅱ ALI group in which ALI was induced by oleic acid 250 mg?kg~(-1) i.v.;Ⅲ,Ⅳ and Ⅴ ALI+propofol group in which propofol was continuously infused i.v.at 4, 8 and 16 mg?kg~(-1)?h~(-1) for 4 h immediately after i.v.oleic acid.The animals were killed at 4 h after oleic acid administration.The lungs were immediately removed for(1)examination of ultrastructure of the lung with transmission electron microseope and(2)determination of SOD and MPO activity,content of MDA,level of IL-10 and IL-18 and expression of NF-kB in lung tissue.Results In group Ⅱ intravenous oleic acid produced damage to mitochondria,rough endoplasmic reticulum and osmiophilic multi-lamellar body in type Ⅱ alveolar epithelial cells. Propofol infusion in group Ⅲ,Ⅳ and Ⅴ attenuated the damage to different degrees.In group Ⅱi.v.oleic acid produced significant decrease in MPO and SOD activity and significant increase in MDA content,IL-10,IL-18 and NF-kB expression in lung tissue.Intravenous propofol infusion attenuated the decrease in MPO and SOD activity, increase in IL-18 expression and MDA content and NF-kB expression in lung tissue produced by i.v.oleic acid, but increased IL-10 expression in lung tissue further.The best protective effect was seen in group Ⅳ.Conclusion Propofol i.v.infusion at 4-16 mg?kg~(-1),h~(-1) can inhibit the oxidative response and inflammatory response and down-regulate NF-kB expression in lung tissue.Propofol infusion at 8 mg?kg~(-1)?h~(-1) provides best protective effects.

OBJECTIVE:To provide reference for prescriptions audit before payment in hospital pharmacy. METHODS:The management measures of prescriptions audit and intervention before payment in our hospital were introduced. 1 200 outpatient pre-scriptions within 1 year before and after management were subjected to a statistical analysis. The effects of prescriptions audit be-fore payment were evaluated through analyzing and comparing qualification rate of prescription and unqualified prescriptions. RE-SULTS:Our hospital adopted a series of measure to realize prescriptions audit and intervention before payment by clinical pharma-cists,such as using information audit system,formulating audit standard,educating pharmacists,establishing audit job system, prescriptions review and feedback system,setting up communication system,etc. Of the total audited 189 665 prescriptions, 14 581(7.69%)failed to audit and 606 prescriptions hadn’t been revised after 1 year management,with effective intervention rate of 95.84%. Compared with before management,the prescription qualification rate increased from 88.83% to 98.67% after manage-ment(P<0.01). The quantity of overdose,inconformity with medical insurance,overload and other conditions reduced to 0. CON-CLUSIONS:It is feasible for pharmacists to audit and intervent prescriptions before payment in hospital pharmacy to improve pre-scription qualification and promote rational drug use in the clinic.

Objective To compare the effect of botulinum toxin A(BTX-A)applied according to experi- ence with its effect when the application is guided by electrical stimulation on spasticity in the ankle plantarflexors of children with cerebral palsy(CP).Methods Forty-five children with CP were randomly assigned into 2 groups to receive injections of BTX-A guided by electrical stimulation,or injections of BTX-A guided by experience.All chil- dren received a local injection in the ankle plantar flexors.Physiotherapy and ankle-foot orthoses were applied by a physical therapist 3 days after the BTX-A injections.After the first 10 days,the therapy was administered by the patient's family.Clinical assessments included the patient's passive range of movement(PROM),scoring on the Ash- worth scale(MAS),the composite spasticity scale(CSS),and the D and E dimensions of the gross motor function measure(GMFM),and walking velocity(WV).Assessments were performed before treatment and at 3 days,2 weeks,1,2,and 3 months following the injection with BTX-A.Results All children showed significant decrease in spasticity(PROM,MAS and CSS)after 3 days.The improvement was maintained at 3 months.When compared with the results before the injection,the improvements in standing and walking(GMFM)and in walking velocity were statistically significant after 2 weeks of treatment for both groups,and were maintained at 3 months.The differences in PROM and CSS scores at 3 days,2 weeks,1,2,and 3 months following the injection were statistically significant between the 2 groups.Significant differences were also found between the 2 groups in MAS scores at 3 days,2 and 3 months after treatment,and in GMFM and WV at 2 and 3 months after treatment.Conclusions A BTX-A injec- tion,whether guided by electrical stimulation or experience,in combination with physiotherapy,can reduce spasticity in the ankle plantarflexors of ambulant children with CP and improve their functional performance.BTX-A injection guided by electrical stimulation was more effective than an injection guided by experience.

Objective To observe the effect of transcranial low frequency electrical stimulation on the contents of monoamines in ischemic area of rats with middle cerebral artery occlusion(MCAO).MethodsPermanent MCAO model of Wistar rat was established with silk thread enveloped with polyammoniacum.The ischemic areas received various intensity of transcranial low frequency electrical stimulation for 1 hour in rats underwent 1 hour of ischemia.Then the affected tissue was processed with fluorospectrophotometry to determine the contents of dopamine(DA),noradrenalin(NE) and 5-hydroxytryptamine(5-HT).ResultsCompared with the sham-operation group,the contents of DA,NE and 5-HT in ischemic area of MCAO model rats decreased obviously(all P<0.01),while all three monoamines investigated in the sham-operation group with transcranial low frequency electrical stimulation had no significant change.In the MCAO groups stimulating with lower(10 V) and middle(30 V) intensity transcranial low frequency electrical field,the contents of DA,NE and 5-HT in ischemic area had no significant increase.But in the MCAO group stimulating with high(50 V) intensity transcranial low frequency electrical field,the contents of DA,NE and 5-HT in ischemic area increased significantly(P<0.05).ConclusionSome degree of intensity transcranial low frequency electrical field stimulation can increase the contents of DA,NE and 5-HT in ischemic area of rats subjected to MCAO.

Objective To investigate the clinical significance of pulse high-volume hemofiltration (PHVHF) on expressions of Toll-like receptor (TLR) 2 and TLR4 mRNA in peripheral blood mononuclear cells (PBMCs) in patients with severe sepsis.Methods Forty patients with severe sepsis were divided into conventional treatment group (n =20) and PHVHF group (n =20) according to random number table.Another fifteen healthy volunteers served as controls.TLR2 and TLR4 mRNA expressions in PBMCs were detected using RT-PCR and plasma concentrations of TNF-α and IL-6 were measured using ELISA method before therapy and at 24 h,48 h and 72 h after therapy.Vital signs,BIL,Cr,BUN,Lac,PaO2/FiO2,acute physiology,chronic health evaluation Ⅱ (APPACHE Ⅱ),sequential organ failure assessment (SOFA) and prognosis were compared among the groups.Besides,complications associated with PHVHF therapy were monitored.Results Expressions of TLR2 and TLR4 mRNA in PBMCs and concentrations of TNF-α and IL-6 were significantly higher in patients with severe sepsis than in the controls (P ＜ 0.01).At 72 hours after therapy,PHVHF group showed significantly lower concentrations of TNF-α and IL-6 than those before therapy (P ＜ 0.01) as well as significantly lower expressions of TLR2 and TLR4 mRNA in PBMCs than those in conventional treatment group (P ＜ 0.O1).However,no significant decline in the levels of TNF-α and IL-6 and the expressions of TLR2 and TLR4 mRNA in PBMCs were shown in conventional treatment group after therapy.At 72 hours after therapy,PHVHF group showed significant increases of MAP and PaO2/FiO2 and significant decreases of Cr,BUN,Lac,APACHE Ⅱ and SOFA as compared to those before therapy (P ＜ 0.05).Moreover,the differences of MAP,PaO2/FiO2,Cr,BUN,Lac,APACHE Ⅱ and SOFA were statistically significant between and conventional treatment group at 72 hours after therapy (P ＜ 0.05).Conclusion PHVHF achieves a reduced systemic inflammatory response,improved major organ functions,shortened length of stay in ICU and down-regulated TLR2 and TLR4 expressions in PBMCs that may be a novel mechanism of PHVHF in treatment of severe sepsis.

AIM:Investigating the expression of HIF-1α,apoptosis of retinal cells and the role of HIF-1α in apoptosis in rats' retinal ischemia-reperfusion injury.METHODS:The rat model of experimental retinal ischemia-reperfusion injury was established by increasing the intraocular pressure to 110mmHg(1kPa=7.5mmHg)in rat eyes.At different time points of post ischemia,the expression of HIF-1α of the retina was detected by immunohistochemicalstaining,and apoptosis of the retinal cell was detected by terminal deoxynudeotidyl transferase medialed deoxyuridine triphosphatebiotin nick end labeling(TUNEL).RESULTS:HIF-1α appeared in the cells of retinal ganglion layer and inner nuclear layer at 2 hours after ischemia.The expression reached to a peak,12 hours after retinal ischemia-reperfusion,then the expression was dedined.The apoptotiC Cells were mainly in inner nuclear layer and could be detected at the 12th, 24th and 48th hour after ischemia,the peak value was the group of 24th hour.CONCLUSION:Expression of HIF-1α in the rats' retina is greatly enhanced after ischemia-reperfusion,which may be involved in the retinal injury:the injury of retinal neurons Occurs partly in the form of apoptosis.The expression of HIF-1α may play an important role in cell apoptosis.

Objective To evaluate the value of neutrophil CD64 positive cells percentage(CD64%)detec-tion to stop using antibiotic in patients with severe pneumonia.Methods 60 accepted antibiotic therapy patients with severe pneumonia,in accordance with the random number table,were separated into observation group(n =30)and control group(n =30).Antibiotics were stopped according to CD64% in observation group,while it according to the clinical symptoms,the plasma level of white blood cell and C -reactive protein in control group.The main observation indexes included the days of antibiotics use,the length of Intensive Care Unit(ICU)stay,clinical efficacy and the case fatality rate.Results The days of antibiotics use in the observation group was (10.3 ±5.2)d,while it was (16.8 ± 5.8)d for patients in the control group,and it had significant difference(t =-4.570,P <0.01).The length of ICU stay in the observation group was shorter than that in the control group[(6.5 ±3.5)d vs (10.5 ±4.5)d],and it had significant difference(t =3.843,P <0.01).The clinical efficacy were 83.67% and 82.12%,and the case fatality rate were 9.68% and 10.24% in the observation group and control group,respectively,and both had no significant difference(P >0.05).Conclusion Stop using antibiotics according to the neutrophil CD64 % is safe,reliable,and can effectively reduce the excessive use of antibiotics and shorten the length of ICU stay in patients with severe pneumonia.