Background Conventional studies showed that the primary pathological change of diabetic retinopathy (DR) is retinal microangiopathy.However,recent studies found that the disorder of visual function appears prior to retinal microangiopathy in diabetic patients.Thereby,this findings can not be explained by conventional view.Objective The aim of the study was to find the change of retinal nerve fiber layer (RNFL) by frequency domain optical coherence tomography(OCT) in the diabetic patients without retinal microangiopathy and with non-proliferative DR (NPDR) and investigate the relationship between the change of RNFL thickness and DR.Methods Sixty eyes of 56 patients with 2 type diabetes mellitus were enrolled in Shanxi Eye Hospital from October 2012 to September 2013.The patients were divided into the non-diabetic retinopathy (NDR) group (30 eyes of 26 patients) and NPDR group (30 eyes of 30 patients) depending on the findings of fundus fluorescine angiography (FFA) according to the DR International Clinical Classification System.Thirty normal eyes of 30 age-and gendermatched healthy volunteers were included as controls.RNFL thicknesses around optical disc and macular zone were measured by OCT,including average RNFL thickness in 360°,superior nasal,superior temporal,temporal,inferior temporal,inferior nasal and nasal RNFL thicknesses.The measuring results were compared between the three groups.Results The total average thickness values of RNFL around the optic disc for the NDR group,NPDR group and the control group were (97.46-± 8.65) μm,(100.69 ± 16.35) pm and (109.22 ± 8.69) μm,respectively,and the parameters in the NDR group and NPDR group were significantly lower than those in the normal control group (P=0.001,0.006).The RNFL thicknesses were thinning at the superior temporal,temporal,inferior temporal,inferior nasal quadrants around optical disc in NDR group compared with the normal control group (P=0.001,0.001,0.001,0.010),and RNFL thickness values of all the quadrants were decresed in the NPDR group compared with the normal control group,and significant differences were seen in superior temporal and nasal quadrants (P =0.001,0.046).The total average thickness values of RNFL around macular zone for the NDR group,NPDR group and the normal control group were (33.47±3.39),(36.81±3.21) and (38.18±2.16) μm,and parameters in the NDR group was significantly lower than that in the normal control group (P =0.001).The RNFL thicknesses of all the quadrants around macular zone in the NDR group were thinned in comparison with the normal control group (all at P＜0.01),and the RNFL thicknesses at the superior nasal,superior temporal and temporal quadrants were significantly decreased in comparison with the normal control group (P=0.026,0.015,0.001).Conclusions The thinning of the RNFL thickness occurs prior to retinal microangiopathy in diabetic patients,and it may be an early pathological stage for DR.

Objective To compose a scientific, systematic and operative nursing quality evaluation system for neonatal blood exchange transfusion, and to provide a reference for quality control of clinical nursing practice. Methods Semi-structured interviews were conducted, the related literature was reviewed, and a preliminary Delphi enquiry questionnaire with the frame of structure quality, process quality and outcome quality was ultimately formed. Through Delphi enquiry questionnaires and analytic hierarchy processing method, all the indictors and the weights were affirmed. Results Totally 19 experts participated in the inquiry, the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively, theχ2 test of Kendall′s W coefficients was significance with P<0.01. The nursing quality evaluation system for neonatal blood exchange transfusion was finalized with 3 level-1 indicators, 9 level-2 indicators and 39 level-3 indicators. Conclusions The nursing quality evaluation system developed through this study can provide practical reference to clinical nursing practice.

Objective To study radiologic (molybdenum target X-ray) findings of ductal carcinoma in situ (DCIS) of breast.Methods The molybdenum target X-ray findings of breast DCIS confirmed by operation or pathology in 20 cases were analyzed.All cases were examined with molybdenum target X-ray at axial and lateral oblique positions in both breasts.Results Among 20 patients,16 cases presented calcifications in the lesions,3 cases showed simple masses,1 case appeared as small dense focus.Conclusion Calcifications are mainly X-ray appearances of DCIS,special attention should be payed to the signs such as masses,small dense focus and so on.

Objective To evaluate the efficacy and safety of pentoxifyline (PTX) on the treatment of collagen-induced arthritis in rats. Methods Wistar rat arthritis model was induced by bovine Ⅱ collagen (BⅡC) . The rats were randomly divided into four groups including normal control group, CIA control group treated with normal saline, indometaein group and PTX group. The body weight, the hind paw volumes, the arthritic index of all rats at different time points were observed and measured. At the end of the experiment, the radiographic changes and the synovial pathology score of rat ankle joints were evaluated to analyze the treatment role of PTX on CIA inflammation. Results The collagen-induced arthritis model was induced successfully at 11~13 days after first immunization with type Ⅱ collagen. After administration, the rat weights of PTX group were higher than that of CIA group (P<0.01) and no significant difference was found between PTX group and normal control group since week three. The degree of swelling of ankle joints in PTX group was decreased since the 17th day. At week five, the volumes of hind paw in PTX group and indometacin group was not different from that in normal control group (P>0.05). Compared with CIA group, the degree of synovial swelling of PTX group and indometacin group was decreased, synovial proliferation and inflammatory cell infiltrations was mild, and vascular hyperplasia and pannus was significantly declined. No cartilage erosion and necrosis was found. The pathological score of PTX group and indometacin group was significantly decreased(P<0.01). The parenchyma of ankle joint was swollen and no osteoporosis and bone erosion was found in PTX group and indometacin group. Conclusion PTX can ameliorate the symptoms and inhibit the swollen of rat arthritis. It is effective and with good safety profile.

Objective To evaluate the value of Compas technique( computed optimun method for profile angle of singht,Compas) in displaying intracranial aneurysms. Methods DSA images of 31 cases of subarachnoid hemorrhage diagnosed by CT were studied. The DSA images in routine A-P and Lateral projections were compared with the images obtained by Compas technique in the same equipment. Results 23 of 31 were diagnosed as intracranial aneurysms by Compas and confirmed by operation, while only 5 were diagnosed definitely with routine A-P & Lateral projections. The other 18 studies were discovered as blurred margin of the artery but indefinite for the diagnosis of aneurysms. There is a statistical difference between the two methods. ?~2=14.93,P

BACKGROUND: Morphine is the first choice for the pain of medium and advanced degrees due to cancer. This is advocated in the Pain Relieving Guide of the WHO. Controlled-release morphine sulfate tablets(CRM) and sustained-release morphine sulfate tablets (SRM) all belong to oral long-acting morphine. It plays an important role in relieving cancer pain effectively and improving their quality of life(QOL).OBJECTIVE: To observe the analgesic effect of CRM and SRM and to observe how they improve the QOL of the cancer patients with severe cancer pain.SETTING: Department of oncology, department of surgery, department of internal medicine and department of traditional chinese medicine in the first affiliated hospital of a university.PARTICIPANTS: During October 1995 to June 1998, all inpatients that were pathologically proved to suffer from malignant tumor with severe pain were recruited into our study.METHODS: There were 182 patients with severe pain due to advanced cancers pathologically proven. They all met the entry criterion of the study. Totally 95 patients were treated with CRM, of which 12 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 83 cases entered the stage of clinical trial. Eighty-seven patients were treated with SRM. Of them 25 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 62 cases entered the stage of clinical trial. The recommended initial dosage of CRM or SRM was 30 mg every 12 hours for all patients, and then the dosage was regulated according to the effects until the ideal anesthesia was achieved.MAIN OUTCOME MEASURES: Assessments included pain severity, the effective rate, complete remission rate, remission time, adverse reactions, and the QOL before and after the treatment.RESULTS: The effective rates of CRM and SRM were 95% and 94%respectively. The complete remission rates were 82% and 80% respectively, and the remission time was(9.1 ±4.1) hours and (8.7±4.4)hours respectively. Statistically, there was no significant difference in analgesic effect and remission time between CRM and SRM. QOL was elevated for a higher degree in 62(75% ) and 47(76% ) patients after the treatment. QOL scores of CRM were (34.6 ± 11.5 ) points before treatment and (52.6 ± 13.0) points after the treatment( P = 0. 000), while QOL scores of SRM were(37.7 ± 9.7) points before the treatment and points (49.8 ± 12.9) points after the treatment (P = 0. 000). There was significant difference in QOL after the treatment. They could relicve osteocope,visceral pain, soft tissue infiltrative pain more effectively than they do about neurological pain.CONCLUSION: Oral treatment with CRM and SRM for the patients with server cancer pain shows a similar analgesic effect. They are effective, safe,and convenient, and can improve the QOL.

Objective To compare the clinical efficacy between single and double volume exchange transfusion for neonatal hyperbilirubinemia,and to verify whether single volume exchange transfusion had advantages in maintaining homeostasis and reducing blood transfusion related complications.Methods Clinical materials of 86 neonates with neonatal hyperbilirubinemia who received blood exchange transfusion,from December 2013 to December 2014,in the diagnosis and treatment center of our hospital were retrospectively analyzed.Cases were divided into the single volume group (35 cases,with a blood volume 80-110 mL/kg) and double volume group (51 cases,with a blood volume 150-180 mL/kg) based on blood volume per kilogram of body weight.Comparisons of the homeostasis changes between pre-transfusion and post-transfusion were performed for each group,and the incidence rate of major adverse events were compared between the two groups.Results (1)In the single volume group and double volume group,the average blood exchange transfusion volumes were (98.16 ± 10.75) mL/kg and (157.78 ± 7.37) mL/kg,the exchange rate of bilirubin were (41.68± 8.52) ％ and (50.22 ± 13.14) ％,and the average time for blood transfusion were (85.60 ±18.66) min and(1 1B.22± 24.81)min respectively,and there were statistically significant differences in the exchange rate of bilirubin and average time for blood transfusion between the two groups (P＜0.05).(2)Compared with pre-transfusion,WBC and platelet (PLT)count,levels of serum total bilirubin (TBIL),albumin,serum potassium,serum sodium,serum chlorine,serum calcium and HCO3-,and pH value were significantly decreased after blood exchange transfusion,while RBC count,PT,APTT and blood glucose were significantly increased in the two groups (P＜0.01).Moreover,the changes of blood glucose,PLT and TBIL in the double volume group were more significantly than those in the single volume group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in the rate of major adverse events between the two groups (P＞0.05).Conclusion Compared with double blood exchange transfusion therapy,single volume exchange transfusion can significantly decrease plasmic bilirubin level with less change of homeostasis,less blood volume for transfusion and less human resources consumption,its value in clinical application is recognized.

BACKGROUND:Numerous diseases like cardiac hypertrophy and intervertebral disc degeneration are known to be implicated in the changes of mechanical stress acting on surrounding tissues or cells, and autophagy contributes to the pathogenesis of these diseases. OBJECTIVE:To review the effects of mechanical factors on autophagy in different tissues and the underlying molecular mechanisms, thereby providing references for the research of autophagy and the prevention and treatment of related diseases. METHODS:A search of Web of Science and PubMed databases was performed for the literatures addressing the effects of mechanical factors on autophagy using the English keywords ofautophagy, mechanicaland the articles were summarized systematically. Finally, 52 literatures were enrolled according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:Mechanical factors make great effects on autophagy of various cells, such as myocardial cells, endothelial cells, chondrocytes and skeletal muscle cells. Autophagy is a self-protective reaction, and the mechanical stress of physiological conditions induces autophagy to maintain cellhomeostasis, normal function and survival. The mechanism of autophagy induced by mechanical stress may involve PI3K-AKT-mTOR, oxygen free radical, AKT-FoxO and other pathways, and the definite mechanism needs to be further studied.

Objective To prepare human prostatic carcinoma-targeted ultrasound contrast agent and assess its targeted ability in vitro. Methods Human prostatic carcinoma-specific polyclonal antibody PSM(C-15) was attached to the surface of self-made liposome microbubbles by electrostatic attraction to prepare targeted microbubbles. Immunofluorescent staining assay was used to identify the combination of PSM(C-15) with liposome microbubbles and the targeted microbubbles were added to prostatic-carcinoma cells and then observed under the light and fluorescence microscope to evaluate the targeting ability of the targeted liposome microbubbles with prostatic carcinoma cells in vitro, while the common liposome microbubbles were controls. Results Targeted microbubbles were positive in immunofluorescent straining assay. In vitro study of the targeting ability showed the targeted microbubbles could actively adhere to LNCaP cell. While the control was negative. Conclusion The targeted liposome contrast agent with highly specific biological activity was prepared successfully. The contrast agent could bind to human prostatic carcinoma cells specially and effectively in vitro.

Objective To investigate the role of Wnt/β-catenin signaling pathway in the osteogenic differentiation of human dental pulp stem cells (hDPSCs). Methods After 14 days of the calcium hydroxide training, the cytoskeletal changes of hDPSCs, the expression of β-catenin, i.e. the key promoter of in the Wnt signaling pathway, and the cell localization were detected by laser scanning confocal technique. The Wnt signaling pathways were up-regulated and inhibited, and the osteogenic differentiation and mineralization of hDPSCs were detected by Western Blot and alizarin red staining after 14 days of the training. Results The cytoskeleton of hDPSCs was rearranged by the effect of calcium hydroxide, and theβ-catenin migration from nucleus to cytoplasm were observed. The number of calcium nodules in hDPSCs was decreased after blocking Wnt signaling pathway by Dickkopf-related protein 1 (DKK-1). The calcium hydroxide treatment can promoted dentin sialophosphoprotein (DSPP) expression in hDPSCs. Conclusions Calcium hydroxide can down-regulate the expression of canonical Wnt signaling pathway and promote osteogenic differentiation and mineralization and odontogenetic differentiation of hDPSCs.