AIM: To evaluate the clinical feature of 9 patients harboring mitochondrial DNA ( mtDNA ) G11778A mutation with Leber hereditary optic neuropathy ( LHON) .
●METHODS: Nine LHON patients were enrolled and followed- up between 2012 to 2015 in Shenzhen Eye Hospital, clinical data were collected and analyzed.
●RESULTS: Six cases had maternal inheritance history ( 67%) . Three were sporadic cases. The patients aged from 9 to 43 years old, with average age of (22. 00±9. 42) years. Simultaneous onset with both eyes was in 5 cases (56%). Successively onset was in other 4 cases (44%). The ratio between male and female was 2:1. In the last follow-up, the visual acuity was finger counted in 2 eyes (11%), 0. 01-0. 1 in 12 eyes (67%), 0. 12-0. 4 in 2 eyes (11%),≥0. 4 in 2 eyes (11%). All patients had pale disc and clear boundary. ln the Humphrey visual field examination, 10 eyes had typically cecocentral or paracentral scotoma, 8 eyes had diffuse visual field defect.
●CONCLUSION: ln the 9 LHON patients with mtDNA G11778A mutation, simultaneous onset cases were more than successively onset cases within 1y cases. In most cases, LHON patients kept stable visual acuity. Rare cases had a raise in visual acuity within 1y. Majority patients had typically cecocentral or paracentral visual field scotoma. In the last stage of LHON, visual field present diffused defect. The secondary affected eye was similar performed defect as the former one.

OBJECTIVE:To observe the efficacy and safety of alprazolam by progressive dose increasing in the treatment of chronic tinnitus. METHODS:Totally 50 patients with chronic tinnitus were included. They were orally treated with Alprazolam tab-let 0.4 mg in the first 1 and 2 week(s),once every night at bedtime;0.4 mg in 3 and 4 weeks,once in the morning and once in the evening;0.4 mg in 5 and 6 weeks,three times a day. If the treatment of tinnitus was invalid,then the gradual withdrawl was conducted by twice a day for continuous 3 d,0.4 mg each time;then once a day,0.4 mg each time,for continuous 3 d. The re-sponders were maintained 12 weeks,and gradual withdrawal was conducted,and followed by follow-up for 3 months. The clinic data was observed,including the clinical efficacy,tinnitus disability scale(THI)score,visual analogue scale(VAS)score,tinnitus loudness(TI)and incidence of adverse reactions before and after treatment. RESULTS:The effective rate was 66.67%;after treat-ment,the scores of THI and VAS,and TI were significantly lower than before,with significant differences(P<0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:The alprazolam by progressive dose increasing has obvious effica-cy in the treatment of chronic tinnitus,with good safety.

Aim To investigate and evaluate the effect of ligustrazine on the expression of scavenger receptor type AI, the human ?-interferon activation site (GAS) elements regulatory systems of SR-AI expression wasfirst established in the Xenopus oocytes. Methods A plasmid, in which the human SR-AI gene was constructed downstream from the GAS elements, was microinjected into the nucleus of Xenopus oocytes. The oocytes then were cultured in the smooth muscle cell conditioned medium (SCM), In which the cell were cultured with the treatment of oxLDL for 2 days. In the other groups, the oocytes were treated with SCM containing the nature medicines ligustrazine, and the positive control drug ?-interferon respectively. Results The results demonstrated that SCM could upregulate the expression of SR-AI in this system, this action was suppressed by ligustrazine and ?-interferon. Conclusion Similar to the action of ?-interferon, ligustrazine can prevent the over-expression of SR-A induced by oxLDL, via their effect on the GAS elements regulatory pathway.

Objective To approach the correlation between angiopoietin-2 (Ang-2) levels and degree of lung injury and prognosis and its clinical significance in patients with acute respiratory distress syndrome (ARDS). Methods A prospective observation was conducted. Fifty-three ARDS patients admitted to Department of Critical Care Medicine of Third Affiliated Hospital of Anhui Medical University from January 2012 to March 2014 were enrolled. According to the criteria of the Berlin Definition of ARDS,the patients were divided into mild group (n=15),moderate group(n=22)and severe group(n=16). Meanwhile,ARDS patients were further divided into survival group(n=29)and non-survival group(n=24)according to 28-day outcomes. Twenty cases of non-ARDS patients were served as control. The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,oxygenation index(PaO2/FiO2),lung injury score(LIS)were recorded within 24 hours after admission. And the plasma levels of Ang-2,interleukin-6(IL-6)and C-reaction protein (CRP)were measured. The independent risk factors of ARDS were analyzed by univariate and multivariable logistic regression. Receiver operating characteristic curve(ROC)was plotted to evaluate the value of Ang-2 in predicting ARDS. Results Compared with non-ARDS group,APACHEⅡ score,SOFA score,LIS score,mortality were significantly increased,PaO2/FiO2 was significantly decreased,and plasma Ang-2,IL-6,CRP were significantly elevated〔APACHEⅡscore:20.7±5.0 vs. 14.1±5.3,SOFA score:7.7±3.5 vs. 3.5±2.1,LIS score:1.69±0.71 vs. 0.28±0.27,PaO2/FiO2(mmHg,1 mmHg=0.133 kPa):159.5±61.3 vs. 394.0±63.2,mortality:45.3%(24/53) vs. 20.0%(4/20),Ang-2(μg/L):4.73(2.59,6.99)vs. 1.22(0.61,1.52),IL-6(ng/L):56.50(27.15,139.90)vs. 13.05(4.38,15.55),CRP(mg/L):95.75(41.74,189.72)vs. 10.56(3.92,21.36),P<0.05 or P<0.01〕. Each index increased or decreased more significantly with the aggravation of the disease. It was shown by correlation analysis that the plasma levels of Ang-2 was significantly positive correlated with IL-6(r=0.468,P=0.000),CRP(r=0.492,P=0.000),APACHEⅡscore(r=0.560,P=0.000),SOFA score(r=0.508,P=0.000)and LIS score (r=0.588,P=0.000),significantly negatively correlated with PaO2/FiO2(r=-0.685,P=0.000). Factors, APACHEⅡ score,LIS score,PaO2/FiO2,Ang-2 and IL-6 founded statistical significance in univariate analysis were analyzed using multivariable logistic regression. High APACHEⅡscore at admission〔odds ratio(OR)=1.316, 95% confidence interval(95%CI)=1.040-1.633,P=0.022〕and increased plasma Ang-2 levels(OR=1.287, 95%CI=1.041-1.760,P=0.038)were the independent prognostic factors for the 28-day mortality in ARDS. The area under the ROC curve of Ang-2 was 0.964,the optimal critical value of Ang-2 was 1.79μg/L,the specificity was 90.0%,and sensitivity was 92.5%. Plasma levels of Ang-2 was better in predicting ARDS than APACHEⅡscore, SOFA score and IL-6. Conclusions The plasma level of Ang-2 was significantly increased in patients with ARDS. The plasma level of Ang-2 was correlated with the severity of acute lung injury and had important prognosis evaluation.

?AIM: To observe the clinical curative effect of the intravitreal injection of anti-VEGF antibody combined with the implantation of Ex-press glaucoma drainage device for neovascular glaucoma ( NG) .?METHODS:A retrospective analysis of 20 patients with NG, who got the intravitreal injection of anti -VEGF antibody combined with the implantation of Ex-press. The visual acuity, intraocular pressure ( IOP ) , iris neovascularization fade and intraoperative and postoperative complications were observed at 1wk, 1, 3 and 6mo postoperatively.?RESULTS:The average IOPs of 20 patients were 47 ± 5.6mmHg, 13.4 ±3.6mmHg, 15.3 ±4.2mmHg, 16.9 ± 5.3mmHg and 18.7 ±6.9mmHg preoperatively and postoperatively 1wk, 1mo, 3mo and 6mo with statistical difference (P<0.05).The intraoperative and postoperative complications of the implantation of Ex-press mainly included early shallow anterior chamber, drainage tube obstruction, filtering bleb scarring. There were 8 eyes with filtering bleb scarring with normal IOP.?CONCLUSION: The intravitreal injection of anti-VEGF antibody combined with implantation of Ex -press is effective for NG, which can significantly reduce the IOP.

Objective To assess the technical feasibility and efficacy of the combined application of a flexible,self-expanding neurovascular stent(Neuroform)and Gugliebni detachable coils(GDC)in the management of wide-necked intracranial aneurysms in humans.Methods Sixty-five wide-necked aneurysms which underwent 65 endovascular procedures were performed by using intracranial stent and GDC.There was a total of 30 aneurysms at basilar artery including 16 at the basilar tip,9 at the basilar trunk and 5 at the beginning of the basilar artery.And there were 30 aneurysms located at the posterior communicating artery, and 5 aneurysms located at the vertebral artery.The Neuroform stents were deployed to cover the neck of aneurysms.Another microcatheter was introduced into the aneurysm sac through the stent interstices and then detachable coils were released to embolize the aneurysms.Results The combined procedures were successful in all of the 65 patients with wide-necked aneurysms.The stent could pass smoothly through the intracranial artery and got released.Complete occlusion was achieved in 60 patients and incomplete occlusion in 5 patients.In-stent thrombosis occurred in 2 patients.All patients recovered well.Forty-two patients had followe-up angiography at 3 to 6 months after the procedure.Among them,no filling was found for the 39 aneurysms which were densely packed,and 3 aneurysms had neck remnant.Conclusion The implantation of Neuroform stent as a complimentary device to GDC coiling is easy and safe for embolization of wide-necked intracranial aneurysms.It has great advantage for treatment of wide-necked intracranial aneurysms.

Objective To screen and isolate the radioresistance related genes of IRM-2 mice.Methods cDNA library of IRM-2 mice was constructed by SMART technique.Total RNA was isolated from spleens of IRM-2 male mice.The first-strand cDNA was synthesized by using PowerScript reverse transeriptase,and double-strand cDNA was synthesized and amplified by long PCR.The PCR products were purified,digested with restriction enzyme Sfi I.The ds-cDNA fragment lessthan 500 bp was fractionated and ligated to the Sfi I-digested pDNR-LIB vector.The ligation mixture was transformed into E.coil DH5α by electroporution transformation to generate the unamplified cDNA library.The quality of cDNA library was identified by PCR technique.130 clones from cDNA library were sequenced and compared with GenBank database.Results The cDNA library contained 2.25 x 106 independent clones with an average insert size of 1.2 kb.The ratio of recombination and full-length was 95% and 55%,respectively.21 pieces of EST sequences from cDNA library were not the same as the known mice genes and registered into GenBank EST database,with registered number DW474856-DW474876.Conclusions cDNA library of IRM-2 mice has been constructed successfully.21 pieces of EST implies that radioresistance correlative genes may be in IRM-2 mice,which will lay a foundation for isolating and identifying radioresistance related genes in further study.

Objective To analyze the incidence,risk factors and pathogens of stroke associated pneumonia (SAP) in patients with acute stroke in the intensive care unit (ICU).Methods One hundred and forty-two patients with acute stroke admitted in ICU from January 2012 to December 2013 were retrospectively studied.The data of medical history of patients,treatment,prognosis,and pathogens of SAP were collected.Data were analyzed by t test,Mann-Whitney U test,Pearson x2 test and muhivariable logistic regression.Results Of 142 patients,94 (66.2％) were contracted SAP of which 54.3％ were early-onset pneumonia (EOP≤72 h) and 45.7％ were late-onset pneumonia (LOP ＞72 h).The most common pathogens isolated from EOP were Staphylococcus aureus and Klebsiella pneumonia,while the most common pathogens isolated from LOP were Acinetobacter baumanii,Staphylococcus aureus and Pseudomonas aeruginosa.Multivariate logistic regression analysis demonstrated that hemorrhagic apoplexy,history of stroke,higher APACHE score,dysphagia,prolonged use of mechanical ventilation,prolonged stay in ICU,and hyperglycemia were the independent risk factors of SAP,and the odds ratios (OR) with 95％ confidence intervals (CI) were 10.917 (1.834-60.959),15.223 (1.947-96.969),1.607 (1.253-2.062),5.321 (1.225-26.519),1.809 (1.208-2.709),1.391 (1.085-1.783),1.534 (1.l01-2.138),respectively.While plasma albumin level was negatively associated with SAP (OR =0.809,95％ CI:0.674-0.971).The common risk factors of EOP and LOP were higher APACHE score and prolonged use of of mechanical ventilation.The independent risk factors of EOP were dysphagia (OR =4.331,95％ CI:1.330-14.098),history of stroke (OR =13.690,95％ CI:2.198-85.277) and chronic bronchitis (OR =12.907,95％ CI:1.203-138.542),While those of LOP were prolonged stay in ICU (OR =1.687,95 ％ CI:1.131-2.517),hemorrhagic apoplexy (OR =21.657,95％ CI:1.559-106.752) and low plasma albumin level (OR =0.782,95％ CI:0.637-0.961).There was no significant difference in mortality between EOP (49％) and LOP (44.2％) (P ＞ 0.05),but the mortality of SAP was significantly higher than that of non-SAP group.Conclusions The incidence rate and mortality of SAP are quite high in ICU.The pathogens and risk factors are different between EOP and LOP.This observation results suggest it is important to identify high-risk stroke patients,and to develop a novel treatment strategy and prophylactic measures facilitating limiting the complications of stroke.

Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.