a greater impact,which could account for some pathophysiological changes caused by catch-up growth.

Objective To study the SLC26A4 mutations in children with non -syndromic hearing loss by ge-netic testing method ,for the purpose of investigating etiology and mutation regularity of hearing loss ,and to provide basic information for the molecular diagnosis of hearing loss .Methods Blood samples and clinical data of 137 spo-radic cases with non -syndromic hearing loss and 126 normal controls were collected .The SLC26A4 gene of the pa-tients and normal controls were amplified by polymerase chain reaction (PCR) ,then subjected to automatic DNA se-quencing .Results Pathologic SLC26A4 mutations were identified in 23 out of 137 patients ,and in 23 out of 119 bi-lateral deafness ,mutate rate were 16 .79% and 19 .33% ,respectively .SLC26A4 mutations were identified in 19 out of 20(95% ) patients with bilateral LVA .A total of 11 mutations were identified in the present study ,including 4 novel mutations (E29K(c .85G>A) ,R79X(c .235C> T) ,C282G(c .844T>G) ,V285I(c .853G>A) )and 7 repor-ted mutations .In the present study ,IVS7-2A>G was the most common mutation ,and was detected in 19 out of 23(82 .61% ) patients with SLC26A4 mutations .Conclusion SLC26A4 mutations ,the common reason for non -syndromic hearing loss ,were closely related with LVA .IVS7-2A>G was the most common mutation in SLC26A4 mutant .

The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To evaluate the using of either 225 or 150 microgrammes of mifepristone combined with misoprostol for termination of second-trimester gestation(16～24 weeks).Methods 180 women requesting voluntary induced abortion during gestation 16～24 weeks were randomised to three groups,group 1:oral mifepris- tone 225rag,group 2:oral mifepristone 150mg,and group 3:injected 100rag rivanot by amniocentestis.The total suc- cess rate,once success rate,the interval of having-medicine to uterine-constraction,the volume of bleeding within 2 hours after labour and cervical laceration rate were observed.Results The once success rate of induced labour in group 1 was higher than that in group 2 and group 3(P

Objective To investigate the clinical characteristics, the association with the risk factors of macrovascular complications, the prevalence of microvascular complications between LADA patients and Type 2 diabetes(T2DM). Methods A cross-sectional study of 30 cases of LADA(ICA positive) patients and 60 cases of ICA negative T2DM subjects matched with age, sex and duration.Results As compared with T2DM, LADA cases showed a lower BMI(21 3?0 5 vs 23 3?0.4kg/m 2, P

Objective To evaluate five years results of laser in situ keratomileusis(LASIK)for correction of myopia.Design Ret- rospective case series.Participant 64 patients(126 eyes)with myopia received operation of LASIK.Method 126 myopic eyes were treated with LASIK.Based on the preoperative spherical equivalent refraction(SER),the patients were divided into Group A,B and C(-3.00D～6.00D,-6.25D～-10.00D and -10.38D～-19.88D).Before and after operation,the visual acuity,refraction,anterior seg- ment,funduscopy,intraocular pressures of patients were measured,and the patients were followed-up five years.Main Outcome Measure Visual acuity,intraocular pressure,refraction and complication.Result At five years,in Group A,B,C,uncorrected visual acuity was≥1.0 in 87.2%,69.1%,31.3% patients,and 100%,98.2%,75% had vision of≥0.5.After five years of operation,the re- fraction was -0.70D?0.52D,-1.06?0.13D,-2.46?2.14D in three groups respectively,there was no significant difference between Group A and B(P=0.23);But there was significant statistical difference between Gruop A and C(P=0.008),Group B and C(P=0.021)respec- tively.At the fifth-year,68.3%,45.0% and 23.5% of refraction in Group A,B,C were within?1.00D.Intraocular pressure at the fifth year was 11.91?2.35mmHg,11.31?2.20 mmHg and 9.24?2.20 mmHg respectively.In Gruop B and C,one patient complained glare re- spectively.In Gruop B,one patient's intraecular pressure was elevated after using glueocorticoid.In Group C,one eye was complicated with rbegmatogenous retinal detachment at the second year after LASIK.Conclusion In the follow-up of five years,LASIK is effective and safe.The results in middle and high myopia are better than that in extreme high myopia.(Ophthalmol CHN,2006,15:312-314)

BackgroundThe quest to look for seed cells is a hot spot of cornea transplant research in solving the problem of the lack of donor. Bone marrow mesenchymal stem cells(BMSCs) have been successfully induced into retinal ganglion cells(RGCs) in vivo,but the successful induction of BMSCs into corneal endothelial cells has not been reported.Objective This experiment was to study the transplantation of BMSCs on corneal endothelial surface using the splitting Descemet's membrane. MethodsFour healthy adult rhesus monkeys were divided into the experimental group ( 3 monkeys) and control group ( 1 monkey). Mesenchymal stem cells (MSCs) were isolated from bone marrow by density gradient centrifugation combined with adhering means. The cultured cells were identified by flow cytometry and its ability to differentiate was determined by allowing them to differentiate into adipocytes in vitro and labeled by 5-bromodeoxyuridine ( BrdU ) for subsequent identification. Corneal grafts of 7 mm in size with tearing of the Descemet' s membrane were prepared in the experimental group and control group. After labeling by 5-bromodeoxyuridine( BrdU ) ,cultured cells were transplanted onto the endothelial surface of cornea grafts in the experimental group, but no cultured cells were seeded in the graft of the control group. The corneal grafts were then sutured in situ, and were removed 1,2 or 3 months after operation to examine the distribution and connection between transplanted cells and their morphologic changes under the electron microscope. Results High purity MSCs were harvested by density gradient centrifugation combined with adhering method. Cultured cells reached confluency after 12 to 16 days, presenting with a spindle shape and parallel or swirling arrangement. Flow cytometry analysis showed that 94.26％ of cells were positive for CD29,7. 51％ for CD34 and 4. 02％ for CD45. Larger nuclei filled with plastosomes, golgiosomes and rough endoplasmic reticula were found on the graft under the transmission electron microscope( TEM ). After 3 weeks, MSCs were differentiated into adipocytes where Oil Red O staining resulted in an orange-red staining in the cytoplasm and blue staining in the nuclei. The transplanted cells attached loosely on the endothelial surface of the corneal graft and came in contact with each other in one month. The shape of the cells appeared as spindle-shaped and polygonal after 2 months and became tightly packed after 3 months. The positive cells retained the BrdU label and presented with brown nuclei. No endothelia cells grew in the cornea graft in the control group, with an absence of BrdU labeling. Conclusions Mesenchymal stem cells can be transplanted onto the corneal endothelial surface successfully and form a monolayer using the centrifugation method, and present with good survival and proliferation ability.

OBJECTIVETo investigate the value of direct sequencing of sex-determining region Y (SRY) gene, as well as peripheral blood karyotype analysis, in the diagnosis of disorders of sex development (DSD) among children and adolescents with ambiguous genitalia.

METHODSThe karyotypes of 20 children and adolescents with ambiguous genitalia were determined by conventional G-banding analysis. PCR amplification was used to detect SRY gene in these patients, and direct sequencing was used to judge whether there was SRY gene mutation.

RESULTSOf the 20 cases, 17 were positive for SRY gene, and 3 were negative for SRY gene. Direct sequencing revealed no SRY gene mutation in the positive cases, however karyotype analysis found 4 special karyotypes in these patients: 46, XY, del(Y) (q12)/45, X; 46, XY, add(Y) (p11); 46, XY, r(9); 46, XY, 9qh+.

CONCLUSIONSSRY gene detection can help determine the type of DSD among children and has the advantage of quick detection. Used together with G-banding analysis, it is helpful for primary diagnosis of DSD among children.

Adolescent ; Child ; Child, Preschool ; Chromosome Banding ; Disorders of Sex Development ; diagnosis ; genetics ; Humans ; Infant ; Infant, Newborn ; Karyotype ; Sex-Determining Region Y Protein ; genetics

BACKGROUNDLarge drusen is a known risk factor for the development of late complications of age-related macular degeneration (AMD) and drusen reduction has been found by our previous study. To prospectively evaluate the efficacy and safety of prophylactic laser treatment in Chinese patients with bilateral soft drusen, we examined the structure and function of the macula 8 years after treatment.

METHODSTen patients with more than 10 soft drusen (> 125 mm) and best corrected visual acuity ≥ 20/25 in each eye participated in the study. One eye, with relatively more drusen, was exposed to an argon laser (514 nm) to achieve a barely visible retinal lesion. The contralateral eye was used as a control. Fluorescein angiography, Amsler tests, Fourier-domain optical coherence tomography and visual evoked potential tests were carried out 8 years later.

RESULTSNo choroidal neovascularization was seen in the laser-treated eyes or control eyes. There were no significant differences in visual acuity or P100 latency and amplitude between the laser treated eyes and contralateral eyes (t = 1.685, 1.184; P > 0.05). The thickness of the retinal pigment epithelium of the treated eyes was less than that of the contralateral eyes (t = -4.540; P < 0.05). The full retinal thickness in treated eyes was slightly, but insignificantly, reduced relative to contralateral eyes (t = -1.746; P > 0.05).

CONCLUSIONSThe treatment was associated with a reduction in retinal pigment epithelium thickness elevation compared with the contralateral eyes. Macular function was not impaired.

Aged ; Aged, 80 and over ; Female ; Humans ; Laser Coagulation ; methods ; Male ; Middle Aged ; Retinal Drusen ; surgery ; Wet Macular Degeneration ; surgery

OBJECTIVETo observe the clinical efficacy of combination of traditional Chinese medicine and western medicine in the treatment of patient bitten by agkistrodon halys pallas, and the changes in peripheral blood inflammatory factors (hs-PCR, IL-6, TNF-alpha).

METHODNinty-eight patients were divided into three groups according to their hospitalization dates: the western medicine group, in which 32 patients were treated with antivenom serum (6 000 U) for five days, once every day; the traditional Chinese medicine group, in which 32 patients were treated with anti pit viper No. 2 concentrated decoction (300 mL), twice to three times every day, for five days; and the combined traditional Chinese medicine and western medicine group, in which 35 patients were treated with the combination of Chinese and Western medicine treatment described above. Then blood samples of all of patients were obtained, and serum factors (hs-PCR, IL-6, TNF-alpha) in peripheral blood were measured by Elisa assay. Another 30 health volunteers were chosen as the normal control group.

RESULTThe serum inflammatory factors were significantly higher in all patients of the three groups than that in healthy control before treatment (P < 0.01), and decreased significantly after treatment. In particular, the more remarkable reduction was found in the combined traditional Chinese medicine and western medicine group compared with the western medicine group and the traditional medicine group (P < 0.01). Symptom elimination in the three groups was superior to the western medicine group and the traditional medicine group at the first day and the third day of treatment (P < 0.05, P < 0.01). Total clinical effective rate was 100% in the combined traditional Chinese medicine and western medicine group, 84. 37% in the traditional medicine group and 65.62% in the western medicine group, the clinical effective rate of the combined traditional Chinese medicine and western medicine group was notably superior to that of the western medicine group and the traditional medicine group (P < 0.01).

CONCLUSIONThe serum inflammatory factors increased significantly in patients bitten by agkistrodon halys pallas. Treatment with the combined traditional Chinese medicine and western medicine can significantly decrease the serum inflammatory factors, and increase clinical effect, with more obvious clinical efficacy compared with the western medicine group and the traditional medicine group.

Adolescent ; Adult ; Aged ; Antivenins ; administration & dosage ; Child ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Interleukin-6 ; blood ; immunology ; Male ; Middle Aged ; Snake Bites ; blood ; drug therapy ; immunology ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood ; immunology ; Young Adult