AIM:To explore the possible alteration of refraction and estimate the potential impact of visual quality, investigate the impact of intraocular structure between the simple operation and the combination of phacoemulsification and intraocular lens implantation, and observe the influence among various tamponade materials application.
METHODS: Ultrasound biomicroscopy ( UBM ) and intraocular len ( IOL ) Master were measured for simple vitrectomy patients ( the simple group, 37 eyes ) and vitrectomy combined with cataract surgery patients ( the combined group, 11 eyes ) . Several parameters were measured such as the anterior chamber depth ( ACD ) , angle opening distance ( AOD ) , trabecular iris angle (TIA), axial length (AL), et al . The simple group was further divided into three sub - groups by various tamponade materials in vitreous: silicone oil group, gas group and equilibrium liquid group. All patients were measured including ACD, AOD250, AOD500, TIA500, AL and corneal curvature (K1, K2) parameters preoperatively and 2wk postoperatively.
RESULTS: AOD250, AOD500, TIA500 and AL were decreased 0. 13±0. 21mm, 0. 16±0. 22mm, 8. 68o±9. 72o and 0. 18±0. 24mm ( all P<0. 05 ) respectively in the simple group postoperatively. ACD, AOD250, AOD500, TIA500 and AL in combined group increased 0. 95±0. 54mm, 0. 13±0. 12mm, 0. 22±0. 20mm, 11. 49o±11. 06o, and 0. 45±0.30mm ( all P < 0. 05 ) respectively after operation. Alteration of ACD, AOD250, AOD500, TIA500 and AL were different between simple group and combined group ( P<0. 05). Of data from various tamponade materials sub-groups, ACD, AOD250, AOD500 and TIA500 of the gas group reduced 0. 19±0. 17mm, 0. 14±0. 09mm, 0. 20±0. 12mm, and 12. 02o±6. 64o respectively after operation ( P<0. 05), the AOD250, AOD500, TIA500 and axial length of silicone oil group decreased 0. 19±0. 25mm, 0. 21±0. 26mm, 10. 44o±9. 67oand 0. 23±0. 19mm respectively after operation ( P < 0.05 ) , while equilibrium liquid group had no significant changed in all intraocular structure (P>0. 05). However, neither the corneal thickness nor curvature (K1, K2) were changed postoperatively (P>0. 05).
CONCLUSION:Alteration of anterior segment and axial length in combined group are different from that of the simple group, while the corneal thickness and corneal curvature ( K1, K2 ) are not obviously changed in all groups. Meanwhile, various tamponade materials can also cause different impact on intraocular structure and refraction. In brief, alterations of intraocular structure might cause discrepant refractive changes and potential influence of visual quality.

BACKGROUND:Point resolved spectroscopy (PRESS) or single-voxel spectroscopy (SVS) is always used in the previous researches of magnetic resonance spectroscopy (MRS) and its regions of interest are mainly located in focal zones which can be observed with magnetic resonance imaging (MRI); however, both of them cannot manifest the changes of focal marginal zone. Contrarily, hydrogen magnetic resonance spectroscopy (1H-MRS) can det ect the all regions of brain.OBJECTIVE: To observe the 1H-MRS manifestations of patients with heroin spongiform leucoencephalopathy (HSLE) so as to analyze metabolic regularities of N-acetyl aspartate (NAA), creatine (Cr) and bilineurine (Cho) in brain.DESIGN: Case-contrast observation.SETTING: Department of Neurology, Nanfang Hospital.PARTICIPANTS: Three HSLE patients including 2 males and 1 female who were diagnosed with clinical imaging were selected from the Department of Neurology, Nanfang Hospital from August 2005 to August 2006, and all of them were regarded as the case group. In addition, 10 healthy volunteers were regarded as the control group.METHODS: Siemens Megnetom Vision Plus 1.5T superconductive magnetic resonance (MR) system and standard head coil were used in this study, and then, all subjects were checked with 1H-MRS.MAIN OUTCOME MEASURES: Levels of NAA, Cr and Cho in white matter of frontal, parietal and occipital lobes, metabolic maps of them and ratios of NAA/Cr and Cho/Cr.RESULTS: All 13 subjects were involved in the final analysis. ① NAA level: The level of NAA in white matter of frontal,parietal and occipital lobes of case 1 was lower than that of the subjects in the control group (79.50±21.65, 96.75±16.14,77.05±22.47; 146.07±15.49, 117.77±14.56, 120.83±16.02; P ＜ 0.05, 0.01); meanwhile, white matter of parietal lobes of case 2 and case 3 was also lower than that of subjects in the control group (87.50±7.89, 80.65±11.73, P ＜ 0.01). ② Cr level: There were no significant differences of the Cr level of all subjects in both case group and control group (P＞ 0.05).③ Cho level: Except white matter of frontal lobes in case 1, the level of Cho was lower in the case group than that in the control group (P ＜ 0.01). ④ Ratio of NAA/Cr was lower in the case group than that in the control group, and the radio of Cho/Cr was decreased remarkably. ⑤ Metabolic maps of NAA and Cr manifested a low signal in focal site. ⑥ Ratio of Cho/Cr was obviously reversed in focal marginal zone, but wave of lactic acid was not observed at the same time.CONCLUSION:The area with abnormal metabolites in HSLE patients showed by 1H-MRS is obviously larger than the visible lesion area showed by MRI.There are abnormal metabolites in the adjacent area of HSLE lesions.

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel's diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel' s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel's diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel's diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent (4/9) of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel's diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.

OBJECTIVE:To establish a method for the determination of weight average molecular weight(Mw)and molecular weight distribution (D) of ferric carboxymaltose. METHODS:HPGPC method was adopted to detect the Mw and D of 3 batches of Ferric carboxymaltose injection (imported) and its raw material (self-made). The determination was performed on TSK G4000 PWXL column with 0.1% sodium azide solution with the flow rate of 0.5 ml/min. The detector was refractive index detector;the column temperature was set at 35 ℃,and sample size was 20 μl. The results were calculated with GPC software. RESULTS:RSDs of precision,stability and reproducibility tests were all lower than 3.0%(n=6);Mw and D of 3 imported samples were 157 667 and 1.30;those of self-made samples were 162 000 and 1.42. CONCLUSIONS:The method has high precision,good stability,repeat-ability and durability. It can be used for the determination of Mw and D of ferric carboxymaltose.

AIM: To investigate the antitumor effects of tumor necrosis factor- ? (TNF - ?) and interferon -?(IFN -?) on hepatocellular carcinoma (HCC) . METHODS: Cytotoxicity of the combination of TNF-? and IFN-? on HCC in vitro was measured by using a crystal violet (CV) staining method. Antitumor effects of the combination of TNF- ? and IFN - ? on HCC in vivo were observed by intra - hepatic injection of TNF-? and IFN-? to the tumor in a human HCC nude mice hepatic model. RESULTS: The growth of HCC cells was inhibited by TNF -? alone, which was dose - dependent. The cytotoxicity of TNF -? on HCC was enhanced by incubation with IFN -?. TNF at 107 U/L, or IFN -? at 106 U/L alone killed only 27.1 % or 7.9 of HCC cells, respectively, when combined with IFN -?, it killed 83.7% of HCC cells. A synergistic antitumor effect on HCC in vivo was observed in combination group, as tumor growth inhibition rate was 35.9% compared with 17.2% in TNF-? group and 5.6% in IFN -? group. The survival period of mice bearing tumor was significantly prolonged and serum AFP was significantly decreased in combination group (P

Background Integrin linked kinase is a new component of the cardiac mechanical stretch sensor,modulating myocardiac contractility.Objective To test the hypothesis that enhanced level of ILK expression might protect cardiac function in rats with experiment myocardial infarction.Methods Acute myocardial infarction model was established by left anterior decending coronary artery ligation and were treated with local injection of adenoviral vector expressing ILK(n=8) or placebo(n=8) around the area with myocardial infarction.ILK expression was determined by Western blot.Four weeks after surgery,myocardial function was analyzed by catheterization.Myocardial histology was analyzed by hematoxylin-eosin staining and immunohistochemistry staining.Results Local injection of ILK resulted in increases in expression of ILK reaching a peak level around 2 weeks,and decrease 4 weeks later.Compared with control rats,the rats with ILK transfection had higher +dp/dtmax[(4930.1?1074.8) mmHg/s vs(3325.2? 775.9) mmHg/s,P

ObjectiveTo investigate the managements of complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).MethodsData of 119 EA patients who underwent POEM from October 2010 to July 2011 were collected.Complications during and after POEM and during follow-up were analyzed.Results Complications during operation included bleeding in 19 patients ( 16.0％ ),mucosa rupture in 9 (7.6％),mediastinal and subcutaneous emphysema in 27 (22.7％ ) and pneumothorax in 3 (2.5％ ).Complications occurred at the night of procedure included pain in 43 (36.1％ ) patients and pneumothorax in 7 ( 5.9％ ).Postoperative complications included asymptomatic pneumothorax in 23 patients (19.3％),delayed hemorrhage in 1(0.8％),pleural effusion in 58 (48.7％ ),minor pulmonary inflammation or segmental atelectasis in 59 (49.6％),emphysema of mediasti-na and subcutaneous tissue in 76 (63.9％ ),and gas under diaphragm or aeroperitoneum in 47 (39.5％ ).Complications during follow-up included one case of dysphagia caused by stricture of mucosa and one case of dehiscence at the tunnel entry with food retention.No POEM-correlated death occurred.All the complications were cured by conservative treatments.No additional surgery was needed.ConclusionMain complications as emphysema of mediastina and subcutaneous tissue,pneumothorax,aeroperitoneum and bleeding during and after POEM can be treated timely and effectively with conservative treatment.

Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.

Objective To investigate the application of 1H-MR spectroscopy in predicting the value of each grade range and grading of glioma invasion. Methods A restrospective analysis was conducted on the preoperative biopsy or posoperative pathology confirmed glioma in 33 cases. Cerebral gliomas were graded into four categories based on the stan?dard of WHO(2007):grade I, II, III andⅣ. All patients underwent MRI and 1H-MR spectroscopy before operation. The 1H-MR spectroscopy analysis was used to analysis metabolite NAA,Cho,Cr and NAA/Cho, NAA/Cr, Cho/Cr in the tu?mor area, peritumoral region and normal area. Results 1H-MRS revealed that there were no significantly differences in Cho, Cho/Cr, NAA/Cho between the peritumoral region and tumor area of grade I glioma (P<0.025). However, there were significantly differences in Cho, Cr, NAA/Cho, Cho/Cr ratio between peritumoral region and the normal brain tissue of grade I glioma (P<0.025). There were significantly differences in NAA, NAA/Cho, NAA/Cr ratio between peritumoral re? gion and the tumor area of grade II glioma (P<0.025). There were statistically significantly differences in Cho, NAA, Cr, NAA/Cho, NAA/Cr, Cho/Cr ratio between the peritumoral region and normal brain tissue of Grade III orⅣglioma (P<0.025). The ratio of Cho/Cr and NAA/Cho were correlated with the pathological grade(F values were 403.9 and 159.46, P<0.05), and the ratio of NAA/Cr and NAA/Cho were decreased gradually whereas the ratio of Cho/Cr was gradually in?creased(F=119.91,P<0.05). Conclusion The 1H-MR spectroscopy analysis has a predictive value in evaluating the lev?el of glioma invasion and determining the grading of glioma before surgery, which is very helpful for the surgical plan and the scope of resection, thereby reducing the recurrence and prognosis of the patients after surgery.

Objective To determine the capability of emergency physicians (EPs) after goaldirected training to make accurate judgement and assessment of left ventricular systolic function (LVSF) as they own manipulated the hand-held echocardiography.Methods Eighty-one patients with acute dyspneic symptom admitted into emergency department of Xinhua Hospital Affiliated to Shanghai qaotong University School of Medicine from November 2011 to February 2012 were enrolled for a prospective,observational study.Patients with a history of trauma or acute myocardial infarction diagnosed by electrocardiogram were excluded.Four EPs after a intensive course of goal-oriented training in a good command of trans-thoracic echocardiography (TTE) in 81 emergency patients using hand-held echocardiography.EPs attempted to obtain images at the parasternal (long and short axis),apical,and subcostal positions,and visually estimated left ventricular ejection fraction (LVEF) and categorized LVSF as normal function,mild or moderate or severely depressed function.The results of echocardiographic LVEF got by EPs were compared quntitatively with those measured by an professional echocardiographer.The kappa statistical test by using SPSS version 13.0 software was used to allow for comparison in agreement between EPs and the professional echocardiographer's interpretations of TTE findings.Results Using the results of TTE measured by the professional echocardiographer as agold standard,EPs correctly distinguished the normal LVSF from decreased LVSF in 89％ patients.The rate of positive predictive value for the EPs identifying any abnormality in LV function was 83％ and the rate of negative predictive value was 93％.The kappa coefficient for the agreement between EPs and the professional echocardiographer' s interpretations for any abnormality in LV function was 0.77 (95％ CI:0.70-0.84,P ＜ 0.01).EPs correctly placed LV function into one of three categories in 68 of 81 cases (84％),The kappa coefficient for the agreement was 0.71 (95％ CI:0.64-0.78,P ＜0.01).Conclusions Emergency physicians after a intensive course of training in mastering echocardiography can accurately determine the left ventricular systolic function.