?AIM:To investigate the causes and characteristics of retinal detachment after vitrectomy.?METHODS: Retrospective analysis of patients in our hospital in recent 4a who underwent primary, standard, three -port pars plana vitrectomy ( PPV ) . Retinal detachment occurred in 24 eyes ( 23 cases ) , 24-67 years old, average 49.0±12.0 years old.There were male in 17 cases, female in 6 cases, 6 right eyes, 18 left eyes.?RESULTS:Eighteen (75%) eyes without any symptoms were found during a routine check, 6 eyes ( 25%) with decreased visual acuity or in front of shadow.It took 1-223d from PPV to retinal detachment, average 40.7 ± 54.2d, of which retinal detachment occurred in 10 (42%) eyes within 1wk, 14 (58%) eyes within 1mo.The direct cause of retinal detachment was new retinal break ( a total of 27 holes ) in 19 eyes, proliferative vitreoretinopathy ( PVR) in 4 eyes, 1 eyes with primary hole not closed.All retinal detachment were ultimately completely reset.?CONCLUSION: The occurrence of new retinal breaks is the main cause of retinal detachment after vitrectomy, attention should be paid to the early postoperative peripheral retinal examination;after a timely surgery, the retina can be reset.

There are many subjects related to anesthesiology and the band between anesthesiology and clinical practicevery is close. So students can not be proficient in anesthesiology by traditional teaching methods. The use of three-dimensional case teaching method in anaesthesiology teaching is a good attemptment. three-dimensional case teaching method integrate case method, multimedia technology and clinical case. It can help medical students analyze and solve clinical problems, improvetheir academic performance and enhance their clinical basic skills.

Objective To explore the clinical characteristics and prognostic factors of breast carcinosarcoma.Methods Clinical data of 37 breast carcinosarcoma patients treated at Tianjin Cancer Hospital from 1974 to 2014 was analyzed retrospectively.Kaplan-Meier unvariate analysis was used to calculate the survival rate and compare the survival rates.Multivariate factors for survival were analyzed by COX proportional hazards regression model.Results 37 cases of breast carcinosarcoma were all female.The median age was 55 years.Among them 31 cases complained for painless mass,six cases had breast mass with skin ulceration.21 cases were three-negative breast cancer.Ten cases had axillary lymph node metastasis,ten cases had distant metastasis.The 5-year survival rate was 62.3％.Unvariate analysis showed that axillary lymphnodes metastasis (P =0.045) and therapeutic schedule (P =0.016) significantly influenced the oulcome of the patients.COX multivariate analysis validated that the therapy modality was an independent prognostic factor for breast carcinosarcoma(P =0.041).Conclusions Breast carcinosarcoma is rare and has a poor prognosis.ER,PR and HER-2 expressions in most cases are negative.If there is axillary lymph node metastasis,the prognosis is poor.A reasonable and comprehensive treatment can improve the prognosis.

ObjectiveTo analyze the mental health level and the correlative factors of elderly reflux esophaditis patients.Methods86 elderly reflux esophagitis patients were tested with Symptom Check List-90 (SCL-90) and the Correlative Factor Inquiry List.ResultsThe total SCL-90 scores of the patients was 137.5±27, the number of symptomatic items was 29.9±17, which was significantly higher than that of domestic norm ( P<0.01). Besides of psychopathic and phobic, other factor scores of SCL-90 were also significantly higher than that of domestic norm ( P<0.05～0.01). The somatization, depression and anxiety were first three factors according to significant level. The constitution of patients showed the normal distribution at the level of total SCL-90 score.ConclusionMental health level of elderly reflux esophaditis patients is lower than that of normal people. The two primary reasons are long-term trend and stress of disease.

ObjectiveTo investigate the clinical effects of posterior atlantoaxial fusion fixation in treatment of old atlantoaxial injury secondary to atlantoaxial dislocation.MethodsA retrospective analysis was carried out on 16 patients ( 14 males and 2 females) with old atlantoaxial injuries secondary to atlantoaxial dislocations managed with posterior atlantoaxial fusion fixation from March 2008 to March 2012.The time from injury to operation lasted for 3-36 months ( average 10.5 months).Posterior atlantoaxial transpedicular fixation was performed in 13 patients including 10 patients with old odontoid fractures and three with old traumatic transverse ligament disruptions of the atlas combined with atlantoaxial dislocations.Also,posterior atlantal arch transpediclar fixation combined with axial pedicle screw fixation was performed in three patients who had old odontoid fractures combined with atlantoaxial dislocations.All patients had simultaneous autogenous bone grafting between atlas and axis during reduction and fixation.The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were compared.Follow-up X-ray films and CT was performed to evaluate the atlantoaxial reduction and fusion.ResultsAll the patients were followed up for 9-18 months ( mean 13 months).None of the patients had spinal cord or vertebral artery injuries.Follow-up CT showed that two patients had partial penetration of one side axial pedicle screws into transverse foramen without nerve and blood vessel injuries.Clinical symptoms obtained different degree of improvement.The postoperative JOA scores ranged from 13 to 16 points ( mean 14.8 points) and the improvement rate of JOA was 71％-92％ ( mean 82％ ).The X-ray films and CT showed sound bone fusion,with good location of screws but with no signs of atlantoaxial instability or loss of reduction,or loosening or breakage of the screws.ConclusionPosterior atlantoaxial fusion fixation can effectively reconstruct atlantoaxial stability,improves neurologic function of spinal cord and has reliable curative effects.

Objective To comment the severity of severe hand,foot and mouth disease(HFMD)by pediatric risk of mortality score(PRISM),and assess the performance of PRISM in predicting mortality or complication probability in HFMD.Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from 1th Jan 2010 to 31th June 2013.Information on the outcome and the varia-bles required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic (ROC)curve to assess discrimination pneumorrhagia and death.Calibration across deciles of risk was evalua-ted using the Hosmer-Lemeshow goodness-of-fit χ2 test.Results The area under the ROC curve were 0.87 (95%CI 0.80~0.94 )for PRISM in predicting pneumorrhagia probability.The area under the ROC curve were 0.87(95%CI 0.80~0.95)for PRISM in predicting mortality probability.The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals (χ2 =36.66, P<0.001 ).The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali-ty risk intervals(χ2 =41.11,P<0.001).Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.

Objective To investigate the clinical and MRI characteristics of reversible splenial lesion syndrome (RESLES).Methods The clinical data,MRI features and follow-up results of 18 patients with RESLES were analyzed retrospectively.Results The average age of the patients was younger,and 5 cases were below 1 5 years old.Clinical history and MRI features were characterized.About 67%(12/18)patients had fever,headache,encephalitis,history,without long history of alcohol abuse.MRI revealed that the lesions of splenial of corpus callosum were solitary nodule with clear boundary.The lesions were slightly hyperintensity on T2 WI and obviouslyhyperintensity on FLAIR and DWI,while the they show hypointensity on ADC with the ADC value <1×10-3 mm2/s.No edema or significant enhancement were observed.The lesions may completely disappear or relief on DWI after short treatment.Conclusion RESLES is a rare entity with a broad clinicoradiological spectrum.The MRI features are characteristic,and it will provide helpful information for diagnosis, differential diagnosis and clinical treatment.

Objective To study the changes and significance of the frequencies of circulating follicular helper T cells (cTfh) and circulating regulatory follicular T cells (cTfr) as well as the cTfh/cTfr ratio in neuromyelitis optica spectrum disorder (NMOSD).Methods The frequencies of cTfh,cTfr and B cells in patients with NMOSD and health controls(HCs) were measured by flow cytometry.Enzyme-linked immunosorbent assay was used to detect the level of IL-21 and AQP4-Ab in patients and HCs.Results The frequencies of cTfh and B cells,the cTfh/cTfr ratio and the plasma level of IL-21 werc significantly higher in the relapsing patients than those in the remitting patients and HCs(P ＜ 0.05),and the cTfr level in the relapsing patients was lower than that in the remitting patients and healthy population (P ＜ 0.05).But no statistical differences were observed in the above indexes between the remitting paticnts and HCs.There was also no significant difference in AQP4-Ab level between the patients with relapse and remission (P ＞ 0.05).The frequency of cTfh in the patients wasc positively correlated with the level of B cells and IL-21(P ＜ 0.05),and the frequency of cTfr was negatively correlated with B cells and IL-21 (P ＜ 0.05).The ratio of cTfh/cTfr was positively correlated with B cell frequency and IL-21 level (P ＜ 0.05).AQP4-Ab level had no correlation with the frequencies of cTfh cells and B cells,cTfh/cTfr ratio and IL-21 concentration (P ＞ 0.05).Conclusion The changes in the frequencies of cTfh and cTfr as well as the imbalanced cTfh/cTfr ratio may promote the activation of humoral immunein NMOSD and participate in the pathogenesis of this disease.

Objective To analyze the risk factors of emergence agitation (EA)in the adult patients during the recovery peri-od after general anesthesia in postanesthesia care unit(PACU).Methods 2 056 adult patients undergoing elective surgery under general anesthesia in PACU were selected,aged more than 18 years old,sex unlimited The following factors of age,gender,body mass,ASA grade,preoperative combined disease,education level,premedicatiou,general anesthesia mode,midazolam use for induc-tion,anesthesia time,operation site,operation mode,operation time,intraoperative blood loss,intraoperative fluid replacement,re-covery time in PACU,body temperature,urinary catheter,urine volume,etc.were recorded.According to whether EA occurring during recovery from general anesthesia,the patients were divided into the quiet group and the EA group.The multivariate Logistic regression was performed to analyze and screen the risk factors for the occurrence of EA.Results 127 cases developed EA during recovery from anesthesia.The occurrence rate of EA was 6.18%.The Logistic regression analysis indicated that high grade ASA, large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain were the risk factors for EA(P <0.05).Conclusion Highgrade ASA,large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain are the risk factors for EA during the recovery period after general anesthesia in PACU.

To explore the material basis and anatomy constitution of meridian in Chinese medicine so as to probe the essence of meridian. Based on the pictures obtained with the 3.0T MRI, the habitat of fascial connective tissue in the upper limb of human was marked and the structure was reestablished through the picture division and the three-dimensional reconstruction. This structure is similar to the meridian as recorded in the Chinese medicine in contrast to the pathway of each other. Thus, fascial connective tissue in whole body might be the anatomic basis for the meridian in Chinese medicine.
Adult ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; methods ; Male ; Meridians ; Radiography ; Upper Extremity ; anatomy & histology ; diagnostic imaging