· AlM: To analyze the clinical data of 54 cases misdiagnosed as optic neuritis and to explore measures to reduce misdiagnosis
· METHODS: This retrospective study comprised 54 patients that had been misdiagnosed as optic neuritis from September 2000 to June 2013. The misdiagnosis features were summarized.
· RESULTS:Many diseases can easily be misdiagnosed as optic neuritis, including ischemic optic neuropathy, intracranial tumors, optic nerve vasculitis, myelinated nerve fibers, and so on.
· CONCLUSlON: The measures to reduce misdiagnosis consisted of detailed history collection, perfect physical examination and comprehensive expertise of fundus disease.

BACKGROUND:An amyloid-beta (Aβ) aggregation in the brain can induce nerve cel apoptosis, loss of synapses and functional damage. However, there is stil no effective intervention. Improving the synaptic plasticity provides an important direction for the treatment of early Alzheimer’s disease. OBJECTIVE: To screen the best model of Alzheimer’s disease and to explore the expression of synapse-associated proteins in Aβ25-35-injured PC12 neurons. METHODS:PC12 cels were induced by 50 μg/L nerve growth factor to differentiate into neuronal-like cels. Then, these cels were treated with Aβ25-35 at different concentrations. Consequently, cel survival rate was detected using cel counting kit-8; neurogranin and neuregulin immunofluorescence stainings were used to observe morphological changes of model cels; western blot used to detect the expression level of neurogranin, calmodulin kinase II, postsynaptic density-95 proteins. RESULTS AND CONCLUSION:Over time, the survival rate of PC12 neurons induced by Aβ25-35 was decreased in a dose-dependent manner. Shortened synaptic length, neuronal atrophy and sparsely interconnected neurons were visible. Expression levels of neurogranin, calmodulin kinase II and postsynaptic density-95 proteins were al down-regulated. These findings indicate that to screen the cel model of Alzheimer’s disease, the optimal concentration and interventional time of Aβ25-35are 10 μmol/L and 48 hours, respectively.

OBJECTIVE To prevent the nosocomial infection event in the clinical laboratory. METHODS To enhance the conception of self-protection,amplify necessary rules and regulation,fine technique training,establish the health-record of the department staff,purchase the facilities of protection,and disinfect the instrument and environment of laboratory even the test report sheet. RESULTS By means of above mentioned measures and management,it could control in most degree of nosocomial infection in clinical laboratory,and ensure the safety and health of the department staff. CONCLUSIONS The nosocomial infection event of clinical laboratory can be prevented by amplification of necessary rules and regulation as well as enhancement of the management.

Orbital surgery is one of the most complex surgeries in ophthalmology, with many clinical ethics issues.This paper aims to analyze the implementation process of all kinds of orbital surgeries in the view of ethics, and to explore the relevant clinical ethical issues and countermeasures during the orbital surgery.

OBJECTIVE:To provide reference for safe and effective use of anti-infective agents in the clinic. METHODS:The utilization of anti-infective agents in hematology department of our hospital from 2009 to 2013 was analyzed statistically using con-sumption sum,DDDs,the ratio of the serial number (the ratio of the serial number of consumption sum to the serial number of DDDs),DDC. RESULTS:There were 5 kinds of anti-infective agents,such as β-lactam and its compound preparations,antifungal drugs,fluoroquinolone and glycopeptide. From 2009 to 2013,the percentage of anti-infective agents with the ratio of serial num-bers≥1 were 70%,60%,70%,60%,65%,respectively. CONCLUSIONS:From 2009 to 2013,the utilization of anti-infective agents in hematology department of our hospital is rational on the whole. However,the cheaper drugs with good synchronism should be used.

Objective:To explore best drug treatment regimen through the participation of clinical pharmacists in the drug treat-ment of one patient with multidrug-resistant Acinetobacter baumannii meningitis intracranial infection. Methods: Clinical pharmacists joined in the treatment team and designed the treatment plan. The individualized dosage regimen was made out through the choices of drugs, dose and administration route, and taking the ADR of drugs into consideration. Results: The intracranial multidrug-resistant Acinetobacter baumannii infection was controlled by the sensitive antibiotics. Cefoperazone sulbactam and minocycline were both effec-tive in the treatment of Acinetobacter baumannii intracranial infection. Conclusion:Clinical pharmacists should provide clinical consul-tation for physicians to ensure the safety, effectiveness and economic of patients’ medication.

Objective To study the development of visual function in blepharophimosis-ptosis-epianthusinversm syndrome(BPES) and evaluate the clinical effect of Multistage Correction.Design Retrospective case series.Participants 51 cases of BEPS in Beijing Tongren Hospital from June 2005 to May 2009.Methods Refraction and general ophthalmology were performed for each patient. Family history was inquired and corrected surgery were performed for every one.Main Outcome Measures Refraction,the length, width of palpebral fissure,and inner canthal distance were measured both preoperatively and postoperatively.Results 13 of the 51 cases had family history,27 cases had amblyopia and 12 cases had refractive error.4 cases combined with strabismus.Conclusions The risk of refractive error and amblyopia in patients with BPES is much higher than that of normal population,so careful regular visual follow -up and early surgery are necessary.BPES patients tend to have much more chance to get amblyopia,which will impact on the development of visual function,therefore surgery correction at early age is highly suggested.

ObjectiveTo investigate the application of the ratio of early diastolic peak velocity of mitral valve(E) and early diastolic peak velocity of mitral annular(Ea) on evaluating left ventricuiar diastolic function in patients with chronic heart failure.MethodsLeft atrial diameter(LAD),left ventricular end-diastolic diameter (LVEDd),interventricular septal thickness (IVST),left ventricular ejection fraction (LVEF),E and late diastolic peak speed of mitral valve (A) of 30 patients with diastolic heart failure(DHF,DHF group),30 patients with systolic heart failure(SHF,SHF group) and 30 healthy persons (control group) were detected by conventional echocardiography.E/A ratio and E-wave deceleration time (DT) were calculated.Early diastolic peak velocity of longitudinal septal and left ventricular lateral part of mitral annulus (Esep,Elat) were measured by tissue Doppler imaging (TDI).Ea and E/Ea ratio were calculated as well as the relevant analysis was made.Results ( 1 ) LAD and IVST in DHF group were significantly higher than those in control group [(44.90±8.31) mm vs.(30.87±3.48) mm,(9.43±2.18) nn vs.(8.17 ± 1.12)mm,P＜0.05].LVEDd in SHF group was obviously higher than that in control group and DHF group [(66.30 ± 10.21) mm vs.(44.77 ± 4.17) mm,(48.60 ± 8.85) mm,P＜0.05],and LVEF and DT were significantly lower than those in control group and DHF group(P ＜ 0.05 ).(2) Esep,Elat and Ea in DHF and SHF group were significantly lower than those in control group( P ＜ 0.01 ),and E/Esep,E/Elat and E/Ea ratios were obviously higher than those in control group (P ＜ 0.01 ).( 3 ) The level of B type natriuretic peptide (BNP) in DHF and SHF group was significantly higher than that in control group [(477.73 ± 722.76),(978.60 ± 825.04) ng/L vs.(29.23 ± 17.84) ng/L,P ＜ 0.05 ].The level of BNP in SHF group was significantly higher than that in DHF group (P＜0.05 ).(4) Multivariate linear regression analysis showed that NYHA classification and BNP were correlated with E/Ea ratio (P ＜ 0.05).(5) The area under curve (AUC) of E/Ea in diagnosing chronic heart failure was 0.984 (95％ CI:0.000-1.000).AUC of E/Ea in identifying DHF and SHF was 0.857(95％ CI:0.773-0.940).The sensitivity and specificity of E/Ea were much higher than those of E/A.Conclusions Chronic left ventricular systolic insufficiency is commonly combined with different-degree diastolic dysfunction.The evaluation of left ventricular diastolic function can be more simple and accurate combined with pulse wave Doppler and TDI.

Objective:To establish an HPLC method for the determination of gabapentin and the related substances in gabapentin capsules. Methods:A Kromasil C8 column (250 mm × 4. 6 mm,5μm)was used. The mobile phase was methanol-0. 01 mol·L-1 po-tassium dihydrogen phosphate solution (adjusting pH to 6. 9 with 2 mol·L-1 potassium hydroxide) (40∶60). The detection wave-length was 210 nm. The column temperature was 40℃ and the injection volume was 20μl. The main component and the known impuri-ty were determined by an external standard method. The unknown impurities were determined by a self-control method. Results: The calibration curve of gabapentin was linear within the range of 2.5-20.0 mg·ml-1(r=0.999 9). The average sample recovery was 100. 74% with RSD of 0. 24%(n=5). Conclusion:The method is simple, accurate,specific and applicable in the determination of gabapentin and the related substances in gabapentin capsules.

Objective:To investigate the protective role of heme oxygenase-1 and its reaction product,carbon monoxide against acute liver injury induced by carbon tetrachloride in rats.Methods: Thirty male Sprague-Dawley rats were randomly divided into six groups with five in each.The control group received a single dose of corn oil injection.Carbon tetrachloride was injected intraperitoneally(i.p) to establish acute liver injury models in rats.Hemin(50 ?mol/kg) was administered i.p.12 hours before CCl_4 treatment,with an aim to induce HO-1 protein expression in the liver of rats.Carbon monoxide was injected i.p.12 hours prior to CCl_4 injection,resulting in about 8%-12% carboxyhemoglobin concentration in vivo.The expression of HO-1 in the liver of hemin-treated rats was determined by western blot method at different time points.At 24 h after carbon tetrachloride administration,all rats were sacrificed to collect blood samples for the examination of ALT,AST levels and to remove liver tissues for analysis of MDA concentration,SOD activity and caspase-3 activity as well as TNF-a contents.In addition,histopathological changes were investigated and hepatocyte apoptosis was detected by TUNEL method.Results: The administration of carbon tetrachloride to rats caused a marked hepatic damage,characterized by significant elevation of serum ALT,AST levels(2 136.3?163.4 U,1 422.7?221.7 U) and liver MDA con-tent(5.28?0.93 ?mol/g),caspase-3 activitiy(optical density value(4.69)?1.02) and TNF-? level(256.3?27.3 ng/L) combined with a remarkable reduction in liver SOD activity(45.9?14.8 U/mg) as compared with the control rats.Histopathological observations revealed severe damage in the liver and prominent hepatocyte apoptosis took place in CCl_4treated rats.However,pretreatment with hemin could induce high expression of HO-1 protein and exert potent protective effects against liver injury,as demonstrated by a significant decrease in ALT,AST levels(287.1?24.3 U,246.2?21.7 U) and MDA concentration(3.27?1.34 ?mol/g),reduction in caspase-3 activity(optical density value 2.49?1.47) and TNF-? level(132.6?19.5 ng/L),as compared with the CCl_4-treated rats.Moreover,hepatocyte apoptosis and liver injury were both attenuated remarkably in the liver of rats pretreated with hemin.In contrast to hemin administration,single injection of exogenous CO produced the same protective effects,as indicated by the remarkable reduction of ALT,AST levels and caspase-3 activity and TNF-a levels.Conclusion: The above results suggest that HO-1/CO system has a potent protective effect on acute liver injury induced by carbon tetrachloride in rats.Induction of HO-1 expression and low concentration of CO can inhibit the progress of hepatic damage,which might be due to the alleviation of lipid peroxidation and reduction of caspase-3 activity or inhibition of TNF-? level.