Objective To analyze the clinical characteristic,treatment and prognosis of traumatic macular holes resulted from ocular contusion.Methods The clinical data of 47 cases with traumatic macular hole was retrospectively reviewed.The general condition of the patients was summarized,optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes.The patients were divided into observation group and surgery group by the treatment they received,and the prognosis was evaluated.Results Traumatic macular hole occurs mainly in male.In the observation group,the mean diameter of macular hole was(490.0±86.9) μm.During the 12 month follow up,the holes in 7 cases (33.3％) were closed spontaneously,Vision and diameters of 14 cases (57.1％) maintained stable for a long time,the vision of 1 case (3.3 ％) declined mildly and the diameter of 1 case (3.3％) enlarged slightly.Visual acuity was improved significantly at last follow up (Z=-2.40,P＜ 0.05).The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30,5.06;P＜0.05).These data suggests that the macular function was recovered well.In the surgery group,the mean diameter of macular hole was (643.3 ± 125.0) μm and statistically larger than that of the observation group (t=-4.76,P＜0.05).At the last follow-up,visual acuity were not improved significantly (Z=-1.79,P＞0.05).The amplitudes of N1 wave in 6 cases (23.1 ％) improved merely and the difference was not statistically significant (t =1.98,P ＞ 0.05).These data suggests that the macular function was recovered slightly only in a few patients.Conclusions A part of the patients with smaller diameters of macular holes may close spontaneously,and they may get better visual acuity.Vitrectomy may help to close the macular holes in some severe cases,but the improvement of functional outcomes is not significant.

Objective To study the clinical features,pathological characteristics and prognosis of renal cell carcinoma(RCC)in young adults,and to improve the recognition of RCC in young population. Methods The data of 35 young patients with RCC under the age of 35 years from August 1983 to June 2005 were analyzed retrospectively.There were 22 males and 13 females with a mean age of 31 years(age range, 19-35 years).The clinical presentations were as follows:painless hematuria in 12 cases(34%),low back pain in 12(34%),abdominal mass in 2(6%),fever in 3 and Stauffer syndrome in 1.The tumor size was 1.2-13.8 cm in diameter(mean,6.0cm).AJCC staging showed stage I tumor in 8 cases,stageⅡin 4, stageⅢin 18 and stageⅣin 5.Of the 35 cases,28 underwent radical nephrectomy(including simultaneous extraction of the vena cava emboli in 3 cases and extraction with pulmonary lobectomy in 1);5 cases under- went partial nephrectomy;and 2 cases lost the chance of operation(1 of them had biopsy).Results The operations were successful.The postoperative pathologic diagnoses consisted of clear cell carcinoma in 23 ca- ses,mixed cell carcinoma in 5,papillary cell carcinoma in 2,and chromophobe cell carcinoma in 2,low-dif- ferentiated and undifferentiated cell carcinoma each in 1.Of them,26 cases were followed for 12-148 months(mean,56 months).Postoperative 3-and 5-year survival rates were 65% and 50%,respectively. Conclnsions In young population,RCC is difficult to diagnose because of occult symptoms at early stage and lack of tumor specificity,which leads to relatively late clinical staging at diagnosis.RCC is characterized by higher malignancy,easy invasion to surrounding tissues and metastasis,and thus poor prognosis.

Objective To determine the optimal cut-off value of critical-care pain observation tool (CPOT) in assessing degree of pain in patients undergone craniotomy, and to determine the sensitivity and specificity of CPOT with this cut-off value. Methods A prospective observational study was conducted in Beijing Tiantan Hospital. A total of 118 patients admitted to intensive care unit (ICU) after craniotomy was consecutively enrolled during August 2014 to August 2015. CPOT and visual analogue scale (VAS) were used to assess the pain before, during and 20 minutes after the removal of central venous catheters, and the difference was compared between two scores at three time points. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for evaluation of the sensitivity and specificity of CPOT. Patients' complaint of pain was considered the gold-standard. Results CPOT values (inter-quartile range) before, during and after the procedure were 0 (0-3), 0 (0-6) and 0 (0-2), respectively; while VAS values were 4 (1, 6), 3 (1, 6) and 4 (1, 6), respectively. CPOT value during the procedure was significantly higher than CPOT values before and after the procedure (both P < 0.01). When the optimal cut-off value of CPOT was 1, CPOT showed the highest Youden index before, during and after the procedure (1.183, 1.515, and 1.438, respectively), and showed high specificity (all 100%) and low sensitivity (18.3% and 43.8%, respectively) when assessing the pain before and after the removal of the catheter. The sensitivity and the specificity were high when assessing the pain during the procedure, the sensitivity was 69.4%, and the specificity was 82.1%. When the optimal cut-off value of VAS was 2 before and during the procedure, and was 4 after the procedure, VAS showed the highest Youden index, 1.568, 1.452, and 1.509, respectively. VAS demonstrated high sensitivity and specificity before, during and after the procedure (sensitivity was 97.2%, 95.2% and 75.0%, respectively; specificity was 59.6%, 50.0% and 75.9%, respectively). The area under ROC curve (AUC) of CPOT before, during and after the procedure were 0.592 [95% confidence interval (95%CI) = 0.490-0.693], 0.778 (95%CI= 0.693-0.863) and 0.719 (95%CI = 0.627-0.811), respectively; the AUC of VAS before, during and after the procedure were 0.846 (95%CI = 0.771-0.920), 0.767 (95%CI = 0.681-0.854) and 0.838 (95%CI = 0.767-0.909), respectively. The AUC of VAS before and after the procedure was significantly higher than the AUC of CPOT (P < 0.001 and P = 0.006), while there was no significant difference between the AUC of VAS and CPOT during the procedure (P = 0.826). Conclusion CPOT can be used to assess the pain during painful procedure, and it shows high accuracy, but with poor evaluation effect on pain in rest.

Objective To study the effect of Mycoplasma pneumoniae infection on the coagulation system in children and to clarify its mechanism in order to guide the therapeutic strategy for Mycoplasma pneumoniae infection in clinical practice.Methods A prospective and case control study was carried out in 36 children with Mycoplasma pneumoniae infection in Weifang People ' s Hospital from January through December in 2011.The 36 patients were divided into two groups according to the MP-IgM plasma titers,namely low-titer group with MP-IgM 1 ∶ 80-1 ∶ 160 (n =17) and high-titer group with MP-IgM 1 ∶ 320-1 ∶1280 (n =19).The subjects of control group (n =20) were recruited from healthy children as they took routine physical examination during the same period.Six indexes related to the coagulation function as well as D-dimer in plasma were determined.All data were analyzed by using SPSS 15.0 software.Results The levels of fibrinogen (FIB) and D-dimer in the low-titer group and high-titer group were significantly higher than those in the control group (P ＜ 0.05).The prothrombin (PT) and activated partial thromboplastin time (APTT) in the high-titer group were significantly shorter than those in the control group respectively (P ＜ 0.05).Conclusions Mycoplasma pneumoniae infection in children gives rise to the potential for activating the extrinsic and intrinsic coagulation system,promoting thrombosis and in turn inducing ischemic stroke in serious cases.

Objective To preliminarily investigate the feasibility of MRI-T2* map in evaluating myocardial iron load of myocardial iron overload rabbit models.Methods Eleven rabbits were included in this study and divided into two groups,myocardial iron overload group (n =10) and the control group (n =1).Iron dextrin (dose of 50 mg/kg) was injected in muscles of thigh once a week,totally 12 weeks.Serum iron test and MRI examination were performed before iron injection,and 1 week to 12 weeks after iron injection.MRI scan protocol included short axial T2* map of the left ventricle and cross-section T2* map of the liver.T2* and R2* of the heart and the liver were measured.One rabbit was killed after MRI examination at pre-iron injection,1 week to 8 weeks,11 weeks and 12 weeks after iron injection,respectively.Heart and liver were avulsed to undergo in vitro MRI scan and then paraffin embedded for pathological slices.MRI scan protocol and measurements of the heart and the liver samples were the same to that of in vivo ones.Pearson correlation was used to calculate the relationships between the parameters.Results Myocardial T2* [(32.5 ± 8.3 ms)] and R2* values [(38.4 ± 7.9) Hz] had significant correlation with injecting iron content(1 033.2 ± 673.4 mg),the Pearson coefficients were-0.799 (P =0.001) and 0.770 (P =0.002),respectively.Myocardial T2 had no significant correlation with liver T2* values (r =0.556,P =0.070).T2* values of heart and liver in vivo [(32.5 ± 8.3) ms and (8.8 ± 5.4) ms],respectively had strong correlation with those in vitro [(19.4 ± 6.5) ms and (9.8 ± 5.0) ms],respectively (r =0.757,P =0.007 and r=0.861,P=0.001).T2* and R2* values of the heart and the liver in vivo and in vitro had no significant correlations with serum iron (P ＞ 0.05).On Prussian blue staining slices,blue particles of myocardium,sinus hepaticus and hepatocyte increased with injecting iron content.Conclusions It is feasible for MRI-T2* map to evaluate the myocardial iron load noninvasively.It may provide reliable information for detecting myocardial iron overload in patients with iron overload at an early stage.

Objective To evaluate the role of spinal sigma-1 receptors in the maintenance of bone cancer pain (BCP) in rats and the relationship with extracellular signal-regulated kinase (ERK).Methods Part Ⅰ Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomized into 2 groups using a random number table:sham operation group (S group,n =4) and BCP group (n =20).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the right tibia.Four rats were sacrificed on day 10 after inoculation in S group or on day 3,5,7,10 and 14 after inoculation in BCP group,and the L4-6 segments of the spinal cord were removed to measure the expression of sigma-1 receptors by Western blot.Part Ⅱ Forty female Sprague-Dawley rats,weighing 180-220 g,were randomized into 4 groups (n =10 each) using a random number table:sham operation group (S group),sigma-1 receptor inhibitor BD1047 group (BD group),BCP group,and BCP + BD1047 group (BCP + BD group).On day 10 to 14 after inoculation,normal saline 20 μl was injected intrathecally once a day in S and BCP groups,or BD1047 120 nmol/20μl was injected intrathecally once a day in BD and BCP + BD groups.Mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured one day before inoculation,on day 3,5 and 7 after inoculation,and on day 10,12 and 14 after administration.After measurement of MWT on day 14 after inoculation,the rats were sacrificed and the L4-6 segments of the spinal cord were removed to determine the expression of phosphorylated ERK (p-ERK) by Western blot.Results Part Ⅰ Compared with group S,the expression of sigma-1 was significantly up-regulated and peaked on day 10 after operation in group BCP.Part Ⅱ Compared with S group,no significant changes were found in MWT and p-ERK expression at each time point in BD group,and MWT was decreased and p-ERK expression was up-regulated in BCP and BCP + BD groups.Compared with group BCP,after intrathecal injection of BD1047,MWT was significantly increased and the expression of p-ERK was down-regulated in BCP + BD group.Conclusion Spinal sigma-1 receptors are involved in the maintenance of BCP in rats possibly through promoting phosphorylation of ERK.

Objective To study the expression and significance of miR-26a in intrahepatic cholangiocarcinoma.Methods The expression of miR-26a in 46 intrahepatic cholangiocarcinoma(ICC) tissues and peritumoral tissues was detected by quantitative real time polymerase chain reaction (qRT PCR).The intrahepatic eholangiocarcinoma cell line HCCC-9810 and RBE were transfected with miR 26a mimics and miR 26a inhibitors,respectively,by lipofectamine 2000.The growth curves were constructed by the CCK 8 method.The migration and invasion ability was demonstrated by wound healing and transwell assay.The cell cycle was analyzed by flow cytometry.The potential mechanism was illustrated by Western blotting.Results For the 46 ICC tissues and peritumoral tissues,miR 26a levels were significantly higher in the tumor tissues than in the peritumoral tissues (P＜0.05).Vascular invasion,TNM Ⅲ～Ⅳ stage and lymph node metastasis were significantly associated with high miR 26a expression levels (P＜0.05),but gender,age,tumor amounts,tumor encapsulation,tumor diameter and tumor differentiation showed no significant association (P＞0.05).Enhanced cell proliferation,migration and invasion ability,accelerated G0/G1 phase to S phase transition,activated AKT by PTEN suppression were observed in HCCC-9810 cells with up regulation of miR-26a.Conversely,cell proliferation,migration and invasion ability was inhibited,G0/G1 phase was blocked and AKT was restrained by PTEN increase wkh down regulation of miR-26a in RBE cells.PTEN mRNA in versely correlated with the miR-26a level (r=-0.8272,P＜0.01).Patients with a high miR-26a expression had significantly poorer overall survival (P＜0.05).A high miR 26a exprcssion,multiple tumors and lymph node metastasis were independent prognostic factors of overall survival (P＜0.01).Conclusion Overexpression of miR-26a in intrahepatic cholangiocarcinoma correlated with clinicopath ological features and overall survival,and it potentially promoted tumor proliferation and metastasis through the PTEN/AKT pathway.

Objective To assess the therapeutic effects of activated charcoal on the acute dichlorvos poisoning in rats. Method Thirty male clean grade Wistar rats were randomly (random number) divided into three groups: control group (group A, n = 10), single dose activated charcoal group (group B, n = 10) and multi-dose activated charcoal (group C, n=10). The rats of group A were suffered from 35 mg/kg dichlorvos exposure by oral without activated charcoal and senna. The rats of group B received 35 mg/kg dichlorvos exposure by oral with 175 mg/kg activated charcoal given immediately after dichlorvos exposure and 35 mg/kg senna given half an hour later. In the group C, 35 mg/kg dichlorvos was given to rats by oral with 175 mg/kg activated charcoal given immediately after dichlorvos exposure and 35 mg/kg senna given half an hour later and then every four hours. Blood samples were collected from the carotid artery at different intervals after exposure. DDVP concentration and total blood acetyl-cholinesterase activity were detected. Differences in serum DDVP concentration, Cmax, AUC (0→∞ ), MRT and acetylcholinesterase among three groups were calculated by using ANOVA. Results Serum DDVP levels in single dose group and in multi-dose group were significantly different from those in control group (P < 0.05). The DDVP levels in multi-dose group were significantly different from those in single dose group 4 hours after exposure (P < 0.05). The AUC and Cmax in activated charcoal treatment groups were significantly different from those in control group (P < 0.05). There were no significant differences in MRT among three groups. Fours hours after exposure to dichlorvos,the levels of serum acetylcholinesterase in rats of group B and group C were significantly different from that in rats of group A (P < 0.05), and there was no significant difference in acetylcholinesteras between group B and group C (P > 0.05). Another four hours later, no differences in acetylcholinesterase were found a-mong three groups (P > 0.05). Conclusions The peak concentrations of dichlorvos in blood are lower in group B and group C, and the blood acetylcholinesterase inhibition is quelled by activated charcoal. Therefore, the effects of multi - dose of activated charcoal is better than that of single dose of activated charcoal.

Objective To study the clinical diagnostic value of transvaginal ultrasonic in early cervical carcinema and cervical neoplasis.Methotis The suspected patients with cervical carcinoma and cervical neoplasis were detected with transvaginal ultrasonography,liquid based cytology and cervical biopsy.The sonograms of transvaginal ultrasonic were retrospectively analyzed.Results In early cervical carcinoma and cervical neoplasis,the diagnostic sensitivity of transvaglnal ultrasonic was 90.9%and 83.3%;and the diagnostic specifity of transvaginal ultrasonic was 70.6% and 60.0%;the rate of missed diagnosis of transvaginal ultrasonic was 9.1% and 16.7%.Conclusion Transvaginal ultrasonic plays an important part in the clinical diagnosis of early cervical carcinoma.

BACKGROUND:Elderly patients have more loose bone. After fractures, bones are mostly crushed. Simultaneously, many elderly patients experience many internal diseases. Various organs have dysfunction. Surgery tolerance is poor, which also brings difficulty in treatment with internal fixator, and increases the risk of therapy. Thus, the choice of internal fixation method is not uniform. OBJECTIVE: To compare and analyze the repair effects of proximal femoral nail anti-rotation blade and anatomic proximal femoral locking plate in treatment of unstable intertrochanteric fractures in the elderly. METHODS:A total of 100 elderly patients with unstable intertrochanteric fractures were selected from the Youyi Branch, Kunshan First People’s Hospital from April 2011 to June 2013. They were randomly assigned to two groups. Patients in the experimental group received internal fixation with proximal femoral nail anti-rotation blade. Patients in the control group received anatomic proximal femoral locking plate. After treatment, folow-up was conducted. Operative indexes, postoperative Harris score for hip function and incidence of complications were compared and analyzed in both groups. RESULTS AND CONCLUSION: No significant difference in various indexes was detected in both groups (P > 0.05). Harris scores were significantly better in the experimental group than in the control group (P < 0.05). Postoperative complications were significantly less in the experimental group than in the control group (P < 0.05). These results indicated that internal fixation of proximal femoral nail anti-rotation blade for unstable intertrochanteric fractures in the elderly achieved satisfactory results in the recovery of joint function and had the advantage of few complications.