Objective To observe and explore the effects of transparent cap-fitted colonoscope combined with carbon dioxide injection on the cecal intubation time and detection of colonic polyps during enteroscopy. Methods 216 patients underwent colonoscopy from January 2014 to June 2016 were selected and randomly divided into A, B, C groups according to random number table, 72 cases in each. Group A with transparent cap-fitted colonoscopy, group B with CO2 injection before colonoscopy, and group C combined with the above two methods and then underwent colonoscopy, cecal intubation time and colonic polyp detection rate were compared among the three groups during the inspection. Results A, B, C groups with cecal intubation ratio showed no significant differences (95.8% vs 90.3% vs 98.6%) (χ2 = 5.34, P = 0.069); the sequence of mean cecal intubation time was group Cgroup A>group B (38.9% vs 34.7% vs 23.6%) (χ2 = 4.10, P = 0.129). The sequences of visual analogue scale score after 10 min [(4.35 ± 0.62) vs (4.88 ± 0.85) vs (5.57 ± 1.05)] and 30 min [(3.04 ± 0.37) vs (3.30 ± 0.56) vs (4.41 ± 0.84)] of coloscope withdraw were both group C

Objective To report clinical features,diagnosis and treatment in a case of adult onset Still's disease (AOSD) accompanied by demyelinating encephalopathy.Methods We reported a case of Stills disease with signs of encephalopathy.We also reviewed and discussed the literature on the neurological manifestations in AOSD.Results The 35-year-old patient had recurrent fever and arthralgias for 3 years,headache for 1 month and transient loss of consciousness.Laboratory tests showed non-specific immunological activity.MRI showed tumor-like lesions at left parietal and occipital lobes surrounded by sleeve-like edema.The lesion had significant occupation effect.Biopsy proved the presence of demyelinating changes.The patient recovered favorably after administration of corticosteroids and immunoglobulin.The lesions had almost disappeared on follow-up MRI 4 months later.Conclusions Demyelinating encephalopathy may develop in patient with AOSD.MRI may show tumor-like damage,which is rarely reported in the literature.Diagnosis depends on history,clinical manifestation and neuroimaging.Biopsy provides important information in making diagnosis.Treatment with corticosteroids and intravenous immunoglobulin was found to achieve good recovery.

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 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.

BACKGROUND:Colagen materials have good biocompatibility and biodegradability, but also had some problems such as low mechanical strength, poor resistance to degradation exposed in the process of clinical application. Numerous studies have reported that proper crosslinking could improve the disadvantage of colagen materials, regulate porous network structure, sweling and degradation of colagen materials. OBJECTIVE: To optimize carbodimide crosslinking process of colagen sponge and determine the best process conditions. METHODS:Colagen sponge was cross-linked by carbodimide for the preparation of loose and porous colagen sponge. Meanwhile, we optimized the conditions of cross-linking, in which the selected concentration of carbodimide was 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100 mmol/L, linking time was 2, 4, 6, 8, 12, 16, 20, 24 hours, and linking temperature was 5, 10, 15, 20, 25, 30, 35℃. We evaluated the best process conditions of colagen sponge through the aperture, porosity, water absorption, and degradation rate. RESULTS AND CONCLUSION:The optimal conditions were carbodimide concentration 50 mmol/L, crosslinking temperature 20℃,crosslinking time 6 hours. At this point, the average pore diameter of colagen sponge was 105 μm, the porosity was 79.45%, water absorption was 287.14%, and the degradation rate was 15.04% (2 days). The crosslinking of colagen sponge significantly improved its water absorption and degradation resistance.

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 explore the feasibility of fetal intelligent navigation echocardiography (FINE) in automatic quantitation of cardiac axis (CA).Methods:A total of 62 pregnant women of which 2 with twins′ pregnancy in the second and third trimesters from May to June 2020 in Sir Run Run Shaw Hospital Zhejiang University College of Medicine were enrolled in this non-selective and prospective study. After excluding those who could not be analyzed, they were assigned into four groups according to their CA measuring methods: ①Group with manual measuring CA in systole (CAS); ②Group with manual measuring CA in diastole(CAD); ③Group with CA measured by FINE in three-steps; ④Group with CA measured by FINE in seven-steps. The CAS among groups were compared in order to analyze the consistency and correlation of CAS achieved by different methods, meanwhile, the intra-observer and inter-observer consistency and repeatability were also evaluated.Results:A total of 64 fetuses with 187 volume data were collected, of which 60 cases of fetal data can be included in the study, 57 cases of normal CA, 3 cases of abnormal CA, a total of 158 volume data can be used for data analysis, the success rate was about 84.5%. Because of the small number of abnormal CA cases (3 cases), only 57 cases of normal CA were statistically analyzed in this study. Three-step and seven-step FINE automatic quantitative CA showed significantly different from those obtained with manual measurements of CAD ( P=0.005, P<0.001). There were no significant differences in quantitative analysis of CA between three-step or seven-step FINE and manual measurements of CAS ( P=0.458, 0.883), however, there was no correlation between CA using three-step FINE and manual measurement of CAS ( rs=0.056, P=0.679), but there was a positive correlation between CA using seven-step FINE and manual measurement of CAS ( rs=0.599, P<0.001). The linear regression equation was constructed as follows: Y=10.96+ 0.73 X ( R2=0.431, P<0.001). There was no correlation between three-step method and seven-step method for automatic quantitative CA ( rs=0.158, P=0.241). There was significant difference( P<0.001), but strong correlation between manual measurement of CAS and manual measurement of CAD ( rs=0.973, P<0.001), the average difference was ΔCA=(4.5± 3.8)°. The linear regression equation was constructed as follows: Y=-2.94+ 0.96 X ( R2=0.950, P<0.001). Intra-observer and inter-observer measurements had shown no significant difference in consistency and repeatability (all P>0.05). Conclusions:The measurement of fetal CA by seven-step FINE is superior to the three-step FINE when the fetal CA is in normal range. This may be considered a promising aspect that seven-step FINE automatic quantitation of fetal CA can replace the manual measurement of CAS. Future research is needed to deliminate the reliability of automatic quantification of fetal CA by seven-step FINE with the CA in abnormal range.

Objective To observe effects of hydroxyethyl starch(130/0.4,voluven)on tissue perfusion and serum TNF-α,IL-6,IL-8 levels in patients with severe acute pancreatitis(SAP).Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer's solution group(n =30 per group).In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d;Ringer's solution group daily 20ml/kg intravenously for 5d.Hemodynamic parameters and tissue perfusion indicators were monitored,TN F-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours.Results Compared with Ringer solution group,Voluven group therapy high efficiency,faster raise MAP,ScvO2,Phi value,lower HR,Hct(t =2.785,3.126,4.132,3.168,2.218,all P ＜ 0.05).TNFα,IL-6 after 48h treatment,IL-8 after 96h treatment,both groups were significantly decreased,but the voluven group was significantly lower than Ringer's solution group(P ＜ 0.05).Conclusion Voluven could effectively and quickly maintain hemodynamic stability,improve the hemorheological and tissue perfusion,could be more conducive to improving the pancreatic microcirculation,thus inhibiting inflammatory cytokines TNF-α,IL-6,IL-8 release,and had favorable treatment effect on patients with SAP.

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.