Adult-onset foveomacular vitelliform dystrophy (AFVD) is characterized by gradually loss of vision,subretinal vitelliform macular lesions and retinal pigment epithelium (RPE) atrophy.The electrooculogram (EOG) is usually normal or reduce slightly.On optical coherence tomography (OCT),there are vitelliform substance which deposited between the photoreceptor layer and the RPE layer,and thinner outer nuclear layer above these deposits.OCT angiography can show the superficial and deep retinal capillaries plexus (DCP) above the yolk-like deposits,the choroidal capillary blood flow is reduced and the DCP blood flow is increased near macular.On indocyanine green angiography (ICG),there is choroidal neovascularization under vitelliform substance at early stage and fluorescence leakage in the corresponding retinal region at late stage.There is no effective treatment for AFVD at present,monogenic gene therapy is the most worth looking forward to.Understanding AFVD clinical manifestations,multi-mode imaging features and new advances in treatment can provide a reference for diagnosis and treatment options

Objective To evaluate the postoperative complications and visual quality after manual small incision cataract surgery (MSICS) versus phacoemulsification (PHACO).Methods A systematic review of MSICS and PHACO was conducted by a computer search on Medline,Pubmed,CBM and CNKI and a supplementary manual search was also done.The effect was measured as an odds ratio (OR) and weighted mean difference (WMD).RevMan 5.0 software was used to perform the Meta-analysis.Results A total of 9 articles were included in the Meta-analysis.Naked visual acuity at 1 week after surgery (OR =0.93,95％ CI 0.68-1.27),posterior capsular ruptured after surgery (OR =1.07,95％ CI 0.73-1.58),corneal edema after surgery (OR =0.90,95 ％ CI 0.70-1.16),surgically induced astigmatism at 1 month after surgery (WMD =0.08,95％ CI-0.02-0.17) in MSICS and PHACO was no statistically significant difference (P ＞0.05).Conclusion MSICS is safe and reliable surgery as same as PHACO for the patients with cataract,MSICS is more consistent with China' s national conditions.

By analysis on existing problems of the classification, the suggestions were put forward to provide a reference for improving the classification of medical devices.
Equipment and Supplies ; classification

Objective To investigate the effects of dexmedetomidine on global cerebral ischemia-reperfusion (I/R) injury in rats.Methods Fifty-four adult male SD rats weighing 200-250 g were randomly divided into 3 groups (n =18 each): shame operation group (group S),global cerebral I/R group (group I/R) and dexmedetomidine group (group D).Global cerebral I/R was produced by occlusion of bilateral common carotid arteries combined with hypotension (MAP maintained at 35-45 mm Hg).In group D dexmedetomidine 3 μg/kg was injected iv immediately after I/R,followed by infusion of dexmedetomidine at a rate of 3 μg· kg- 1 · h- 1 until 2 h of reperfusion.The neurological deficit score (NDS) was assessed (0 =normal,100 =brain death) at 6 h (T1),24 h (T2)and 72 h (T3) of reperfusion.Then six rats were sacrificed in each group and brain tissues were removed for microscopic examination of hippocampus CA1 region and determination of activity of myeloperoxidase (MPO),contents of TNF-α and IL-1β and expression of glial fibrillary acidic protein ( GFAP).Results Compared with group S,NDS,MPO activity and the contents of TNF-α and IL-1β at T1-3 were significantly increased,the expression of GFAP was up-regulated at T2,3 in groups I/R and D ( P ＜ 0.05 or 0.01).Compared with group I/R,NDS,MPO activity and TNF-α concent were significantly decreased at T1-3,IL-1β concent was decreased at T1,2,the expression of GFAP was down-regulated at T2,3 in group D (P ＜ 0.05 or 0.01 ).The pathologic changes were significantly attenuated in group D as compared with group I/R.Conclusion Dexmedetomidine can attenuate global cerebral I/R injury in rats,and the inhibition of inflammatory response may be involved in the mechanism.

ObjectiveTo evaluate the factors implicated in the diagnosis and treatment of early gastric caner.Methods Fifty Patients early gastric caner with diagnosed from March 2004 to May 2006,were investigated in the study retrospectively.ResultsAll of the patients were diagnosed accurately by the gastroscopy,among which 2 had atrophic gastritis history for 6 or 10 years,respectively.Twenty-four masses were located in gastric pylorus,12 in gastic angular incisure,14 in gastric body.D2 radical mastectomy was performed in 41 cases,and D1 radical mastectomy in 9 cases.In 10 cases the diameter of tumors was ＜1 cm,17 cases 1 -2 cm,14 cases 2-3 cm,9 cases ＞3 cm.Lymph node involvements were observed in five cases ( 10％ ).Follow data were available in 48 cases.Among them,3 died from local recurrence and metastasis at postoperative 10,12,19 months respectively. Conclusions Although endosopic mucosal resection or limited surgical resection is a reasonable treatment for some early gastric caner patients,D2 radical mastectomy is necessary for most early gastric caner patients.

Objective To evaluate the effects of dexmedetomidine on the permeability of blood-brain barrier in rats subjected to global cerebral ischemia-reperfusion (I/R).Methods Thirty-six male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each):sham operation group (group S),global cerebral I/R group (group I/R) and dexmedetomidine group (group D).Global cerebral I/R was induced by occlusion of bilateral common carotid arteries combined with hypotension (MAP was maintained at 35-45 mm Hg) in anesthetized rats.In group D,dexmedetomidine was infused at a rate of 3μg· kg-1 · h-1 until 2 h of reperfusion after a loading dose of dexmedetomidine 3 μg/kg was injected intravenously immediately after onset of I/R.The rats were sacrificed at 24 h of reperfusion and their brains were immediately removed for microscopic examination of hippocampal CA1 region and for determination of the cell apoptosis,brain water content,Evans blue content and aquaporin 4 (AQP4) expression.Results The number of apoptotic cells was significantly larger,and brain water content,Evans blue content and AQP4 expression were higher in groups I/R and D than in group S (P ＜ 0.05 or 0.01).The number of apoptotic cells was significantly smaller,and brain water content,and Evans blue content and AQP4 expression were lower in group D than in group I/R (P ＜ 0.05 or 0.01).Global cerebral I/R-induced pathological changes were significantly attenuated in group D.Conclusion Dexmedetomidine can decrease the permeability of blood-brain barrier and attenuate global cerebral I/R injury in rats,and down-regulation of AQP4 expression may be involved in the mechanism.

Objective To evaluate the effects of dexmedetomidine on the oxidative stress responses during global cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),global cerebral I/R group (group I/R) and dexmedetomidine group (group D).Global cerebral ischemia was induced by occlusion of bilateral common carotid arteries combined with hypotension (MAP maintained at 35-45 mmHg).In group D,dexmedetomidine was infused at a rate of 3 μg · kg-1 · h-1until 2 h of reperfusion after a loading dose of dexmedetomidine 3 μg/kg was intravenously injected immediately after onset of reperfusion.The neurological deficit score (NDS) was assessed at 24 h of reperfusion,the rats were then sacrificed,and their brains were immediately removed for determination of cell apoptosis and levels of malondialdehyde (MDA),superoxide dismutase (SOD) and catalase (CAT).Apoptotic rate was calculated.Results Compared with group S,NDS,apoptotic rate and MDA level were significantly increased,and SOD and CAT levels were decreased in I/R and D groups.Compared with group I/R,NDS,apoptotic rate and MDA level were significantly decreased,and SOD and CAT levels were increased in group D.Conclusion Dexmedetomidine attenuates global cerebral I/R injury through inhibiting the oxidative stress responses.

OBJECTIVE To explore the reason and the nursing measure of the ventilator-associated pneumonia(VAP).METHODS Fifty five patients with VAP after mechanical ventilation were statistically analyzed and the pathogens were detected,at the same time to carry out comprehensive nursing measure.RESULTS After effective nursing measuring the motality due to VAP was decreased and the successful rescue rate was increased.CONCLUSIONS The VAP associates with various risk factors,but it can be prevented and controalled via overall reasonable and effective nursing measure.

Objective: To establish a method for the determination of cyasterone in Shenshixiao capsules. Methods: Using an HPLC method, the column was an Agilent C18 (250 mm × 4. 6 mm,5 μm) column, the mobile phase was methanol-water with gradient elution. The detection wavelength was 243nm, the flow rate was 1. 0 ml·min-1 ,and the temperature of column was room temperature. Results:The linear relationship of cyasterone was good within the concentration range of 0. 025-0. 247 μg(r=0. 999 6), the average recovery was 99. 4%, and RSD was 0. 76%. Conclusion:The method is rapid, simple and accurate, and can be used in the quality control of the preparation.

Objective To access the diagnostic accuracy and clinical value of transvaginal real time three-dimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy) in evaluating the fallopian tube patency.Methods 428 infertile women were under went transvaginal RT-3D-HyCoSy and 32 of them were underwent laparoscopically salpingoraphy to evaluate the fallopian tube patency.Results 846 fallopian tubeswere studied by RT-3D-HyCoSy,271 of them were unobstructed,202 of them were obstructed,373 of them were partially passable.Compared with laparoscopically salpingography,sensitivity,specificity,positive predictive value and negative predictive value of transvaginal RT-3D HyCoSy were 84.0％,100％,87.5％ and 90.9％,respectively.The transvagianl RT-3D HyCoSy and the laparoscopy with a Cohen's Kappa was 0.788.Conclusions Transvagianl RT-3D HyCoSy could dynamic show the visualization of the course from uterus to distal tubal and the both ovary consecutively.It has more advantage in assessing the patency of tubal and distal tubal function.