Background Vancomycin has been increasingly recommended for the management of endophthalmitis,but few research report has been published about the pharmacokinetics of intravitreal vancomycin up to now.It is necessary to have an exact method to measure the concentration of vancomyein in animal eyes after intravitreal injection.Objective This study was to observe and compare the phamacokinetical process of vancomycin in serum,vitreous and aqueous humor between normal and infected rabbit eyes.Methods Seventy-two healthy adult rabbits were randomly divided into normal group and infected group and 36 rabbits for each.The animal models of endophthalmitis were established by intravitreal inoculation of 2000 CFU/ml staphylococcus aureus in the right eyes of rabbits in the infected group.Once endophthalmitis developed,0.1 ml vancomycin ( 10 g/L) solution was injected into the vitreous of every rabbit.The peripheral blood,vitreous and aqueous humor samples were respectively collected in 4 rabbits for each group at 0.5,2,4,6,12,24,48,72 and 84 hours after injection for detection of vancomycin concentration by high performance liquid chromatography(HPLC-UV).3p97 software was used to create fit parameters of pharmacokinetics.This experiment followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission (Version 1988).Results The accuracy of HPLC fitted the detecting request of biological specimen.The concentration-time data of vancomycin in normal rabbit aqueous humor and vitreous was subject to two-compartment model.The pharmacokinetic parameters were separately as following:Cmax was 50.16 mg/L and 751.42 mg/L,t1/2was 51.04 hours and 53.21 hours.The concentration-time data of vancomycin in infected rabbit aqueous humor and vitreous was subject to one-compartment model.The pharmacokinetic parameters were separately as following:Cmaxwas 24.94 mg/L and 687.66 mg/L,t1/2was 11.42 hours and 12.91 hours.The concentration of vancomycin in serum was much lower and almost undectable.The concentration of vancomycin in vitreous was gradually reduced as the prolong of time after injection in both normal group and infected group,but a obvious decline after increased level was scen in aqueous humor.Compared with normal group,the concentrations of vancomycin in both vitreous and aqueous humor were reduced at various time points(P＜0.05,P＜0.01 ).Conclusions HPLC is simple,highly sensitive and specific for the pharmacokinetic analysis of vancomycon.These results indicate that pharmacokinetic parameters of vancomycin alter in pathological condition,which is helpful for us to establish the better treatment guidelines for endophthalmitis.

Objective To investigate the influence of hyperbaric oxygen treatment (HBOT) on blood pressure (BP) and the incidence of rebleeding in patients with hypertensive intracranial hemorrhage (HICH)Methods One hundred and twenty patients with HICH were treated for 60 min with 100% oxygen at 2.0 absolute atmospheres (ATA) daily when the condition was stable and BP was controlled ideally. Blood pressure was measured before the patients were sent into the HBO chamber and remeasured following completion of each HBOT session and 1 hour later. Rebleeding was monitored during and after each HBO session . Results HBOT caused a significant elevation of systolic BP in 25.83% (31/120) patients and a significant decrease in 16.67% (20/120) patients (P ＜0. 05 ),whereas the rest 57.5% (69/120) patients had no significant changes,when the BP was measured right after the HBOT session. The mean diastolic BP increased in 69 (57. 50% ) patients and decreased in 4. 17%(5/120) patients (P ＜ 0. 05 ), whereas we found no significant changes in the rest 46 (38. 33% ) patients. No differences were found in the comparison of BP before and 1 hour after the HBOT session and no one suffered from rebleeding during and after HBOT session. Conclusions HBOT may cause temporal blood pressure changes in most patients with HICH, however, it will not cause an increasing incidence of rebleeding if the patient's condition is stable and the blood pressure has been well controlled.

SUMMARY To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gall-bladder-hepatic duct subcutaneous tunnel.Retrospective analysis was conducted of the case data of 11 pa-tients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct sub-cutaneous tunnel from January 2010 to October 2014.The operation time,blood loss,postoperative com-plications and recurrence of stones were recorded.All the cases completed the operation.The average hos-pital-stay was 9.2 days (range:3 -29 d).The average operation time was 298 min (range:225 -480 min).The average blood loss was 253 mL (range:50 -700 mL),and the average blood loss of liver re-section groups was 325 mL (range:200 -700 mL).The average discharge time was 3.3 days (range:3 -5 d).The rate of postoperative residual stones was 36.4% (4 /11).We extracted stones with chole-dochofiberscope via T-tube sinus six weeks after operation.One case developed biliary leakage,and healed through adequate drainage and the T-tube was pulled out after one month.There was no periopera-tive mortality.All the cases were followed up and the mean follow-up was 22 months (range:2 -51 months).The anastomotic stenosis of gallbladder-hepatic duct was found in one case.But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol.No recurrence of hepa-tolithiasis was found.As a choice for minimally invasive method to hepatolithiasis using gallbladder-he-patic duct subcutaneous tunnel,total laparoscopy is a safe and feasible procedure.

BACKGROUNDThe relationship between monosymptomatic resting tremor (mRT) and Parkinson's disease (PD) remains controversial. In this study, we aimed to assess the function of presynaptic dopaminergic neurons in patients with mRT by dopamine transporter positron emission tomography (DAT-PET) and to evaluate the utility of clinical features or electrophysiological studies in differential diagnosis.

METHODSThirty-three consecutive patients with mRT were enrolled prospectively. The Unified Parkinson's Disease Rating Scale and electromyography were tested before DAT-PET. Striatal asymmetry index (SAI) was calculated, and a normal DAT-PET was defined as a SAI of <15%. Scans without evidence of dopaminergic deficits (SWEDDs) were diagnosed in patients with a subsequent normal DAT-PET and structural magnetic resonance imaging.

RESULTSTwenty-eight mRT patients with a significant reduction in uptake of DAT binding in the striatum were diagnosed with PD, while the remained 5 with a normal DAT-PET scan were SWEDDs. As for UPRDS, the dressing and hygiene score, walking in motor experiences of daily living (Part II) and motor examination (Part III) were significant different between two groups (P < 0.05 and P < 0.01, respectively). Bilateral tremor was more frequent in the SWEDDs group (P < 0.05). The frequency of resting tremor and the amplitude of postural tremor tend to be higher in the SWEDDs group (P = 0.08 and P = 0.05, respectively).

CONCLUSIONSmRT is heterogeneous in presynaptic nigrostriatal dopaminergic degeneration, which can be determined by DAT-PET brain imaging. Clinical and electrophysiological features may provide clues to distinguish PD from SWEDDs.

Adult ; Aged ; Dopamine Plasma Membrane Transport Proteins ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease ; diagnosis ; Positron-Emission Tomography ; methods ; Prospective Studies ; Tremor ; diagnosis

OBJECTIVETo find an effective therapy for periarthritis of shoulder.

METHODSSixty cases were divided into two groups, 30 cases in each group. They were treated by acupuncture at pain point combined with moxibustion at Zusanli (ST 36) and routine acupuncture, respectively. Pain of the shoulder and movement functions of shoulder joints were used as indexes of therapeutic effects and their therapeutic effects were compared.

RESULTSThe total effective rate was 96.7% in the treatment group and 90.0% in the routine group with no significant difference between the two groups (P > 0.05); the cured rate in the two groups were 46.7% and 20.0% respectively with a significant difference between the two groups (P < 0.05). There were statistically significant differences between the two groups in improvement of movement function of shoulder joints and alleviation of pain (both P < 0.01).

CONCLUSIONAcupuncture at pain points combined with moxibustion at Zusanli (ST 36) in increase of the cured rate and alleviation of pain, and improvement of movement function of shoulder joints is better than the routine acupuncture and moxibustion for treatment of periarthritis of shoulder.

Acupuncture Therapy ; Humans ; Moxibustion ; Pain ; Periarthritis ; therapy ; Shoulder

Aim To observe whether asiatic acid ( AA) can inhibit lipopolysaccharide ( LPS )-induced inflammatory response in VSMCs , and explore its mechanism of action .Methods The VSMCs isolated from aorta of SD rats were primarily cultured . The effect of AA on the cell viability of VSMCs was meas-ured by MTT assay .The protein and mRNA expression of IL-6, MCP-1, and TNF-α, were measured by ELISA assay and real-time PCR, respectively.The protein and mRNA of TLR4 and PPAR-γwere meas-ured by Western blot and real-time PCR, respectively . Results AA exhibited no effect on cellular viability between the concentration from 0 to 30 μmol · L-1 . After treating VSMCs with LPS (500μg· L-1 ) for 6h or 24 h, the protein and mRNA expression of IL-6, MCP-1, TNF-α, and TLR4 significantly increased ( P<0.05 );and on the contrary , the activity of PPAR-γwas significantly reduced ( P<0.05 ) .Treatment with AA (10, 20, 30 μmol· L-1 ) could concentration-de-pendently inhibit LPS-induced protein and mRNA ex-pression of IL-6, MCP-1, TNF-α.AA could also re-duce LPS-induced protein and mRNA expression of TLR4, and pretreatment of the cells with TLR4-siRNA could reduce LPS-induced inflammation . Moreover , treatment with AA could up-regulate the mRNA and protein expression of PPAR-γin VSMCs; however , GW9662 , a PPAR-γantagonist , partially attenuated AA' s anti-inflammatory effect .Conclusion AA can significantly inhibit LPS-induced mRNA and protein expression of IL-6, MCP-1, TNF-α, in VSMCs, which is partially dependent on suppressing TLR 4 and up-regulating PPAR-γ.

Objective To explore the clinical application and effect of the transplantation of the cutaneous fibular flap combined with anterolateral thigh flap for the repair of complex tissue defect of the leg. Methods The cutaneous fibular flap combined with anterolateral thigh flap in series connection or parallel connection transfer were applied to repair complex tissue defect of the leg in 36 cases. 10 cases were fresh non-infectious wound 26 cases were delayed infectious wound. The area of wound ranged from 25 cm × 18 cm to 45 cm × 13 cm (36 cm × 16 cm on average). The area of anterolateral thigh flap ranged from 12 cm × 13 cm to 32 cm × 18 cm. The area of the cutaneous fibular flap ranged from 2.0 cm × 1.5 cm to 18.0 cm × 16.0 era. The length of fibular transplantation ranged from 10 cm to 24 cm. 30 cases were combined in parallel connection transfer, 6 cases were combined in series connection transfer, 5 cases were repaired in emergency, 5 cases were repaired in subemergency, 26 cases were repaired in delay. Results All cases were successfully repaired in 36 cases.35 cases were followed up. A mean follow-up was 29 months. Arterial crisis occurred in 1 case, venous crisis occurred in 2 cases 34 flaps survived completely and 2 cutaneous fibular flap survived partially in parallel connection which were later healed by skin transplantation.32 cases were healed in first stage, 4 cases were healed in second stage, (healing time ranged from 12 to 18 days), Bone healing time ranged from 3 to 6 months in fibula transplantation. The Enneking score system was applied to evaluate the leg function. Of the 35 cases, the mean scores was 26 (their scores ranged from 23 to 28).The functions of all supplied regions were not found malfunctional. Conclusion Transplantation of the cutaneous fibular flap combined with anterolateral thigh flap is an optimal method to repair the complex tissue defect of the leg.

Objective To study the damage propagation and evolution mechanism of cartilage under compressive loads.Methods The fiber-reinforced porous elastic model of cartilage with micro-defect was established by using finite element method,and the process of damage evolution under compressive loads was simulated and analyzed with parameters.The patterns of stress and strain distributions on cartilage matrix and collagen fiber at different damage extension stages were obtained.Results The strain in the surface and forefront of cartilage damage increased significantly with the increase of compression displacement,and they were obviously in positive correlation;in the process of damage evolution,there was a trend that cartilage extended to the deep and both sides simultaneously;cracks and damage in cartilage extended preferentially along the fiber tangent direction.With the aggravation of cartilage damage,the lateral extension speed was significantly faster than the longitudinal extension speed.Conclusions The process of cartilage damage extension has a close relationship with the distribution of fibers.The damages in matrix and fiber promote each other.The evolution speed and degree of cartilage vary constantly in different layers and at different stages.These results can provide the qualitative reference for prediction and repair of cartilage damage,as well as the theoretical basis for explaining pathological phenomena of damage degeneration and its clinic treatment.

Objective To improve the qualified rate of cleaning of loaner orthopedic surgery instruments by application of quality control circle(QCC).Methods QCC activity was carried out in a hospital from May to October 2016, on-site assessment of cleaning quality was performed by two circle members, causes of unqualified cleaning result of loaner orthopedic surgery instruments were recorded, the qualified result of loaner orthopedic surgery instruments before QCC activity(May-June 2016)and after QCC activity(September-October 2016)was compared. Results Before QCC activity, there were 1 667 packages of loaner instruments, 1 415 were qualified for cleaning, qualified rate was 84.88％;after activity, there were 1 673 packages of loaner instruments, 1 655 were qualified for cleaning, qualified rate was 98.92％, difference was statistically significant between two groups(P＜0.01), qualified rate increased to 14.04％, target achievement rate was 116％.Conclusion Application of the scientific tool of QCC can improve the qualified rate of cleaning of loaner orthopedic surgery instruments.

Objective:To investigate the medical students' general understanding of online teaching and online learning of medical courses during the COVID-19 epidemic, and to analyze the satisfaction with online medical curriculum and its influencing factors.Methods:A total of 188 medical students in Xiangya School of Medicineof Central South University were investigated anonymously with a self-designed questionnaire. SPSS 26.0 was used for analyzing the relevant data, t test or variance analysis was conducted fro coparison between groups. The data was described with rate and there was a significant difference when P<0.05.Results:The 88.83% of the students believed that online teaching was much necessary, and the greatest advantage of online teaching was that they could arrange their learning time freely. However, 59.57% of the students thought that the learning consciousness was reduced, and inadaptability to the change of teaching platform (49.47%) and teaching mode of teachers (59.57%) may be the main reasons affecting the teaching quality.Conclusion:Students have a high degree of acceptance of online teaching during the epidemic, but there are some problems such as decreased self-discipline, insufficient interaction between teachers and students, dissatisfaction with the construction of online course platform, inability to visit the laboratory and practice in the hospital, and so on. The investigation is still helpful to revise the medical education model in the post-epidemic period and the future. Our results suggest that the combination of online and offline teaching mode can be adopted in medical theory class and PBL discussion class, and at the same time, the construction of online learning resources for clinical practice and medical experiments should be strengthened.