Objective To explore the mechanisms of coronary artery lesions in patients with Kawasaki disease by detecting thrombomodulin level in both acute and convalescence stages. Methods Fifty-eight patients were recruited in which 34 were male and 24 were female. This group was further divided into coronary artery lesion group(25 cases) and non-coronary artery lesion group(33 cases). Normal control group was consisted of 30 healthy children in which 17 were male and 13 were female. Thrombomodulin was measured by enzyme linked immunosorbent assay. Results Compared with the control group, TM level was increased in the Kawasaki disease group. TM level in the acute stage group and convalescence group was higher than that of the control group, TM level in acute stage group was higher than that of the convalescence group (P<0.05). Compared with non-coronary artery lesion group, TM level of the coronary artery lesion group was increased and the difference was significant (P<0.01). Correlation analysis showed that the TM level was positively related with coronary complications of the Kawasaki disease (r=0.855, P<0.01 ). Conclusion TM increases significantly in Kawasaki disease. It is correlated with the development of coronary artery lesions. In addition, it is also associated with apparent hypereoagulation and thrombocytophilia. TM can predict the development of coronary artery lesions.

Objective To study the effective treatment for severe hypertensive cerebral hemorrhage. Methods 102 cases of severe hypertensive cerebral hemorrhage were randomly divided into two groups: One group with minimally invasive surgery and intravenous drip of wintermine started 1 ～ 5 days after operation, another only with minimally invasive surgery. The 55 subjects with conservative treatment were selected as control group. Results The quality of life in the survival group was better than in group B and C (P < 0.05, or P < 0.01), the mortality of group A was also significantly lower than the other two groups (P < 0.05, or P < 0.01). Conclusion Minimally invasive surgery combined with intravenous drip of wintermine can be a safe and effective method for severe hypertensive cerebral hemorrhage.

Objective To assess the value of three-dimensional double echo steady state with water excitation (3D-DESSwe) MR sequence in depicting the normal anatomy of facial nerve. Methods 3D-DESSwe MR sequence was performed in 15 healthy volunteers on a 1.5T MR. The 3D datasets obtained were constructed in relation to the course of the facial nerve using multi-planar reconstruction (MPR) and thin slice maximum intensity projection (MIP) programs, and the images acquired were compared with anatomical textbook diagrams. Two doctors analyzed the images in collaboration and recorded on an arbitrary scale of 0-2 grades (grade 2, homogeneity and facial nerve identified with certainty;grade 1, mild inhomogeneity and facial nerve probably identified;grade 0, severe inhomogeneity and facial nerve not identified). Results In all subjects, 3D-DESSwe images provided reliable definition of the normal facial nerve anatomy bilaterally and high contrast between the facial nerve and adjacent structures were obtained. The cisternal segment of facial nerve showed high signal intensity while the moving CSF flow surrounding it showed low signal intensity. The internal auditory canal (IAC) segment of facial nerve showed relatively low signal intensity while the stationary CSF surrounding it showed high signal intensity. The labyrinthine, tympanic, mastoid and extracranial segments of facial nerve showed high signal intensity while the bone and soft tissue surrounding it showed low signal intensity, and parts of facial nerve branches could be demonstrated. Conclusion 3D-DESSwe sequence can display the complete course of the normal facial nerve, especially for the intratemporal and extracranial parts.

Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.

Objective To study the changes of AKP activity and its cytochemistry position during liver regeneration following partial hepatectomy. Methods Using colorimetry to analyze AKP activity; using non-denatured electrophoresis technique to analyze the kinds and activity of AKP; using electron microscope cytochemistry to analyze its position. Results During liver regeneration, AKP activity had two peaks at 16*!h and 19*!h and followed by decline dramatically; Three hepatic-derived AKP isoenzymes were detected, and 180*!kD AKP appeared only in liver regeneration; AKP appeared in different part with the process of liver regeneraion.Conclusion AKP plays an important role in liver regeneration and it may involve in cell metabolism, material transportation, DNA synthesis and cell differentation.

Objective:To evaluate the effect of anti-vascular endothelial growth factor (VEGF) in patients with wet age-related macular degeneration (wAMD) and investigate the recurrence factors.Methods:In this case-control study, 40 eyes of 38 patients with wAMD treated by anti-VEGF therapy in Xijing Hospital from October 2015 to April 2017 were included.Ranibizumab or conbercept was consecutively intravitreally injected monthly under 3+ pro re nata (PRN) regimen.All included patients were followed-up at least 12 months.The best corrected visual acuity (BCVA) was expressed in logarithm of the minimum angle of resolution (LogMAR) units.Optical coherence tomography (OCT) was used to observe the morphologic characteristics of macula and measure the central retina thickness (CRT). Patients were divided into recurrence and recurrence-free group based on whether recurrence occurred during follow-up.Potential associated factors with recurrence after treatment were analyzed by multivariate logistic regression analysis.Meanwhile, the morphological and functional response were identified at 1 month after loading phase as well as at last follow-up visit.This study protocol was approved by the Ethics Committee of Shanghai General Hospital (No.2016KY243) and written informed consent was obtained from each patient prior to receiving injection.Results:All the operative eyes showed retinal effusion absorption at least once, and 21 (52.5%) eyes had relapse during follow-up.The patients with lower BCVA (LogMAR) value at the first absorption time had higher risk of recurrence ( OR=16.7, 95% CI=1.22-100, P<0.05). The eyes in the recurrence group received more times of treatment than eyes in the recurrence-free group (5.8±2.3 vs 3.5±1.4, t=3.64, P<0.05). However, there was no significance between the two groups in BCVA change before and after treatment ( t=-1.52, P>0.05). In the recurrence group, the BCVA (LogMAR) and CRT at last visit were 0.73±0.34 and (187.2±81.7)μm respectively, while were significantly improved in comparison with 0.81±0.37 and (234.2±74.5)μm at the relapse time ( t=2.14, 2.62; both at P<0.05). There were 87.5% (35/40) eyes showed good morphological responses at 1 month after the loading phase while 12.5% (5/40) eyes presented poor morphological responses, the retinal effusion was absorbed after additional (3.2±2.2) times of injections.The BCVA of eyes with a good morphological response at 1 month following loading phase was better than that at the first retinal effusion absorption time ( t=-2.23, P<0.05). Average CRT at last visit was significantly decreased in comparison with the baseline CRT ( Z=-4.62, P<0.01). Conclusions:For wet AMD patients, the anti-VEGF treatment is safe and effective in the short term, while there is still a high rate of recurrence.More attention should be paid to eyes with better vision at the first time of retinal effusion absorption which may have more chance to experience recurrence.Patients need long-term follow-up after treatment to prevent recurrence.In addition, the complete loading treatment is needed for patients who have a good morphological response after the first retinal effusion absorbed.

Objective:To investigate the efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia caused by multidrug-resistant Gram-negative (G -) bacteria. Methods:A observational study was conducted. The clinical data of 45 patients with pneumonia due to multidrug-resistant G - bacteria admitted to intensive care unit of Fujian Medical University Union Hospital from January to October in 2020 were analyzed. According to the different use methods of polymyxin B, 25 patients who received single intravenous drip (the first dose was 2.0 mg/kg, then 1.25 mg/kg, once every 12 hours) from January to April in 2020 were enrolled in the routine group, and 20 patients who received intravenous drip combined with aerosol inhalation (25 mg once every 12 hours, sputum in the airway was sucked and then sprayed aerosol) from May to October in 2020 were enrolled in the combination group. After the treatment course of polymyxin B, the total bacterial clearance rate, total clinical efficiency rate, recovery time of body temperature, time of bacterial clearance and the change of serum procalcitonin (PCT) level before and after treatment were compared between the two groups. Moreover, the incidence of adverse reactions during treatment in the two groups was observed. Results:The results of sputum culture in the routine group were Acinetobacter baumannii in 13 patients, Klebsiella pneumoniae in 5 patients, Pseudomonas aeruginosa in 6 patients, Enterobacter cloacae in 1 patient; the sputum culture results of the combination group showed that there were 5 patients of Acinetobacter baumannii, 9 Klebsiella pneumoniae and 6 Pseudomonas aeruginosa. There was no significant difference in the results of sputum culture between the two groups ( P > 0.05). The total bacterial clearance rate and the total clinical efficiency rate of the combination group were significantly higher than those in the routine group (total bacterial clearance rate: 70.0% vs. 40.0%, total clinical efficiency rate: 75.0% vs. 40.0%, both P < 0.05). The recovery time of body temperature and the time of bacterial clearance of the combination group were significantly shorter than those in the routine group [recovery time of body temperature (days): 6.0±3.9 vs. 10.2±7.3, time of bacterial clearance (days): 6.1±5.2 vs. 11.5±6.8, both P < 0.05]. No significant difference was found in serum PCT level before treatment between the two group. There was no significant difference in serum PCT level before and after treatment in the routine group [μg/L: 0.85 (0.44, 2.87) vs. 1.43 (0.76, 5.30), P > 0.05]. The serum PCT level after treatment in the combination group was significantly lower than that before treatment [μg/L: 0.27 (0.10, 0.70) vs. 0.91 (0.32, 3.53), P < 0.05], and it was significantly lower than that in the routine group [μg/L: 0.27 (0.10, 0.70) vs. 0.85 (0.44, 2.87), P < 0.01]. The incidence of renal toxicity of polymyxin B between the combination group and the routine group was not significantly different (5.0% vs. 4.0%, P > 0.05). Conclusions:The efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia due to multidrug-resistant G - bacteria is better than that of intravenous drip of polymyxin B only. The aerosolized polymyxin B will not increase the risk of renal injury.