· 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 explore the proliferation of human degenerate nucleus pulposus and annular fibrosus cell in vitro and compare the different biological behavior between the two kinds of cell after degeneration,and provide the new theoretical basis for the prevention and treatment of degenerative disc disease.MethodsThe samples of intervertebral disc tissue were collected from patients with lumbar disc herniation.The degree of degeneration was assessed by the pathological diagnosis and degenerate nucleus pulposus and annular fibrosus cell were cultured by enzymatic digestion and identified.In each case,the control groups of the nucleus pulposus cells and annulus fibrosus cells were cultured to the fifth generation.The inoculation density of cells was 1×105.The cell morphology of each generation was observed,while the proliferation of cells was detected by flow cytometry after 48h culture with the same conditions.ResultsThe degenerate nucleus pulposus cell and annular fibrosus cell were in good condition in vitro.The percentages of S phase cell and proliferation index (PI) were both on the rise with the subculture.The PI of nucleus pulposus cells reached the peak in the 3rd generation; The PI of annulus cells was the highest in the generation 5.The proliferation activity of degenerate nucleus pulposus cell in 2～4 generations was higher than the degenerate annular fibrosus cell within the same generations (P＜0.05).ConclusionDifferent proliferative characteristics of the degenerate nucleus pulposus and annular fibrosus cell confirmed that the disc degeneration is reversible.The response mechanisms to the degenerate micro-environment are completely different in vivo and affects the entire disc degeneration progress.

Objective: To measure serum testosterone level, plasma levels of interleukin-18 (IL-18) and IL-10 and explore their correlation in patients with different types of coronary heart disease (CHD), and their possible role in occurrence and development of CHD. Methods: A total of 96 male CHD patients were divided into acute myocardial infarction (AMI) group (n=35), unstable angina pectoris (UAP) group (n=32) and stable angina pectoris (SAP) group (n=29). Another 30 patients who were excluded for CHD by coronary angiography were enrolled as non CHD control group. Enzyme linked immunosorbent assay (ELISA) was used to measure serum testosterone level and plasma levels of IL-18 and IL-10 in all groups. Results: Compared with non CHD control group, there were significant decreases in serum testosterone level [(13.46±1.99) mmol/L vs. (6.89±1.35) mmol/L vs. (5.02±1.87) mmol/L, t=1.917～2.365, P<0.05 both] in UAP group and AMI group, and that of AMI group was significantly lower than that of UAP group, t=1.034, P<0.05; there were significant increases in IL-18 levels [(146.72±79.36) pg/ml vs. (209.32±80.49) pg/ml vs. (316.78±75.63) pg/ml vs. (457.78±83.21) pg/ml, t=2.016～3.167,P<0.05 all] in SAP group, UAP group and AMI group, and those of UAP group and AMI group were significantly higher than that of SAP group, t=2.173, 2.596, P<0.05; there were significant increases in IL-10 levels [(48.46±18.27) pg/ml vs. (116.45±42.76) pg/ml vs. (85.64±27.33) pg/ml vs. (70.26±18.55) pg/ml, t=2.997～2.018, P<0.05 all] in SAP group, UAP group and AMI group, and those of AMI group and UAP group were significantly lower than that of SAP group (t=2.034, 2.291, P<0.05 both). Pearson linear regression analysis indicated that serum testosterone level was negatively correlated with levels of IL-10 (r=-0.678, P<0.01) and IL-18 (r=-0.579, P<0.01) in CHD group. Conclusion: There are significant changes in serum testosterone level and plasma IL-18, IL-10 levels, and testosterone level is significantly negatively related with IL-18, IL-10 levels, and they can be regard as new indexes assessing coronary atherosclerotic lesion.

Objective To investigate autoantibody against endothelin receptor type A (ENRA-Ab) in patients with systemic lupus erythematosus associated pulmonary arterial hypertension (SLE-PAH).The possibility of autoantibody-mediated pathogenesis in the development of SLE-PAH has also been explored.Methods ENRA-Ab in the serum of SLE-PAH and controls were detected by using a human ETRA epitope peptide-based ELISA.The clinical relevance of ENRA-Ab in SLE-PAH was analyzed.Proliferation of vascular smooth muscle cells (SMCs) and permeability of endothelial cells in vitro under the stimulation of polyclonal ENRA-Ab IgG were assessed.The expressions of PAH-related markers, i.e., 5-HTT, PDGFR-b, VEGF-A and PDGF-B were measured by qPCR.The effect of ENRA-Ab in vivo was also determined in a suboptimaldose monocrotaline-induced model with the assessment of right ventricle hypertrophy index and pathology parameters.Independent t-test, Tukey-Kramer test of variance analysis and Pearson' s correlation analysis were used for statistical analysis.Results ENRA-Abs was presented in a higher occurrence in SLE-PAH (35/85,41％) compared with controls (0/60;0, 13/80, 16％).There was a significant correlation between ENRA-Ab and echocardiograph estimated pulmonary arterial systolic pressure (r=0.392, P=0.002) in SLE-PAH.ENRA-Ab could promote SMCs proliferation, disrupt endothelial barrier and up-regulate PAH-related markers expression,which could be blocked in the presence of ETR antagonist.ENRA-Ab aggravated right ventricle hypertrophy and vascular remodeling in vivo.Conclusion ENRA-Ab is a new biomarker, in SLE-PAH, which may mediate PAH development in SLE.