Objective To compare the video-assisted laparoscopic lumbar gangliosympathectomy with open lumbar gangliosympathectomy on their advantages and disadvantages. Method From June 2002 to May 2006, a total of 21 adults with Buerger's disease underwent the video-assisted laparoscopic lumbar gangliosympathectomy. The operation time, intraoperative blood loss, hospitalization time, postoperative effects and postoperative complications were analyzed. The data of the 21 cases were compared with those from other 27 cases with Buerger's disease who had undergone open lumbar gangliosympathectomy in the same period. Results The operation time was longer in the laparoscopic group (174?14.84min) than that in the open group (132?32.81min, P

Objective To research regional anatomy of lumbar sympathetic trunk and provide anatomic information for video-assisted laparoscopic lumbar sympathectomy(VALLS).Methods Lumbar sympathetic trunk and its neighboring anatomic relation in 128 sides of adult cadavers and 21 clinic VALLS were retrospectively reviewed.Results ① The location,shape and number of the sympathetic ganglia were quite variable.There was 1 to 6 in number unilaterally.② Lumbar sympathetic trunks of 12 sides in 128 sides were found dividing into 2-3 branches at the distal part.③ Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins consisting 68.42% situated superficially to the trunk.④ Genitofemoral nerve pierced the psoas muscle at the level of 2nd to 4th vertebrate or its intervertebral disc.It was only(0.81?0.48)cm away from the medial rim of the psoas muscle.⑤ Distance between ureter-iliac vessel junction and the lateral rim of the psoas muscle was(3.36?0.59)cm at left side and(3.41?0.59)cm at right side.The operation time was 2-3.5 hours and the intraoperative blood loss was 50-80 ml.There were no severe complications and the effects were satisfying.Conclusion Because of great variants and complex neighboring anatomic relation of lumbar sympathic nerve,the critical factor of successful microinvasive VALLS is to grasp the laparoscopic operation skill and anatomy of retroperitoneal space(especially the regional anatomy of lumbar sympathetic trunk)and carefully operating.

Neovascular age-related macular degeneration is also known as wet age-related macular degeneration (wAMD) , which is now one of potentially blinding diseases in elder population worldwide.The application of anti-vascular endothelial growth factor (VEGF) drugs is becoming the first-line therapy for wAMD at present.However, during the long-term follow up, we find that the vision of some patients dose not improve even falls after treatment, or the vision is unable to keep for a long term after its improvement.Hence,to find the key factors that affect the therapeutical effect is the focus issue nowadays.There are many factors that affect wAMD curative effect,including the limitation of drug itself, the personal conditions of the patients, the features of the choriodal neovascularization (CNV) , the formulation and implementation of the treatment regimen, etc.Imaging features of CNV and treatment timing can serve as the available indexs to analyze the prognosis.In addition,reasonable and optimized managing regimens for wAMD probably is an approach to improve the treating effect.Understanding of the factors that affect curative effect of wAMD is benefit for us to setup the individualized therapy and achieve the best vision.Ophthalmologists should fully recognize the importance of wAMD individualized treatment and management.

Diabetic macular edema (DME) is the most common reason for visual impairment in diabetic eye diseases.DME is easy to relapse and the treatment outcome is beyond satisfied.Anti-vascular endothelial growth factor (anti-VEGF) therapy has been proposed to be a first-line or key treatment regimen in the management guideline for DME.However,in clinical practice,there still are many ambiguous and controversial views in the choice and implement of different managing paradigms,including the therapeutical goal,the assessment of treatment effectiveness,the explanation of the guidelines,the regimen of anti-VEGF therapy,the value evaluation of laser photocoagulation,the use of steroids and the management of recurrent DME.Recently,the researches of treating drugs for DME are developing and making a great progress,so eye doctors should track the research results,improve the therapeutical regimen,fully understand the advantages and disadvantages of different treating methods and standardize the treatment process in order to release the best treatment effects on DME.

This paper reviews the current research of the influencing factors and nursing interventions in traumatic brain injury of patients with increased intracranial pressure.Summarizes the various nursing interventions methods such as position,hypothermia,sputum suction, basic nursing to preventing or reducing increased intracranial pressure of patients. We expect to provide the references in reducing patient′s increased intracranial pressure meanwhile maintaining adequate cerebral perfusion, preventing complications and improving the prognosis.

The therapeutic effect of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) was determined by a number of factors.Comprehensive thorough analysis of clinical features,imaging results and treatment response can predict the potential efficacy and possible vision recovery for the patient,and also can optimize the treatment regime to make a personalized therapy plan.Precise medicine with data from genomics,proteomics and metabolomics study will provide more objective and accurate biology basis for individual precise treatment.The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy,to achieve individualized precise diagnosis and treatment,to improve the therapeutic outcome of nAMD.

[Summary] _ Osteoporosis and diabetes mellitus are diseases which affect public heath severely, and osteoporotic fracture risk is increased in patients with diabetes. During recent years, new anti-diabetes drugs glucagon-like peptide-1(GLP-1) analogues and its receptor agonists had been used for diabetes treatment. As the research continues, besides of anti-diabetes, GLP-1 analogues are also found to play a role in bone metabolism and central nervous system by stimulating bone formation, inhibiting bone resorption, and nerve protection/nutrition, etc, suggesting that it may play an important role in the treatment of other diseases such as osteoporosis.

Objective To study systematically regional anatomy of lumbar sympathetic trunk to provide anatomic information for endoscopic lumbar sympathectomy (VALLS). Method The anatomy of the lumbar sympathetic trunk and its relationship with neighboring structures were studied in 128 sides of adult cadavers, and it was substantiate in 13 cases of endoscopic lumbar sympathectomy. Results (1) The location, shape and number of the sympathetic ganglia were quite variable. The number varied from 1 to 6 on one side. (2) It was found that the lumbar sympathetic trunk split into 2-3 branches at the distal portion. (3) Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins situated superior to the trunk in 68.42%±4.35% of instance. (4) Genitofemoral nerve was found to pierce the psoas muscle at the level of 2nd to 4th vertebra or its intervertebral discs. It was only 0.81±0.48 cm away from the medial rim of the psoas muscle. (5) Distance between ureter- iliac vessel junction and the lateral edge of the psoas muscle was 3.36±0.59 cm on the left side, and 3.41±0.59 cm on the right side. (6) A report of the experience of our 13 VALLS was presented. Conclusions Because of great variation and complicated anatomic relation between lumbar sympathetic trunk with its neighboring structures, familiarity to the anatomy of the retroperitoneal space is cracial for a successful minimal invasive laparoscopic lumbar sympathectomy.

AIM: To improve the acute cumulative death rates method (ACD method) in animal by oral administration. METHODS: A mathematic model was established to evaluate the dose-toxic effect relationship by twice oral administration and the experimental steps were improved too. The methodological quality was explored using the simulation data from computer program and the real experimental date from the reference paper. RESULTS: The results showed that the experimental data could be fitted to its theoretical data from LD_5/2 to LD_ 95/2. Concentration-time curve after po ordinary powder of Semen Strychni in mice were fitted to a one-compartment with T_ 1/2(ka)= 1.136 h,T_ 1/2(ke)= 7.100 h,and T_ max= 3.576 h. CONCLUSION: The improved ACD method can be used in the pharmacokinetics of TCM by oral administration.

Objective To investigate the reason for hidden hemorrhage of hip fracture in elder.Methods All of 94 elder patients,who were diagnosed with intertrochanteric fracture or femoral neck fracture and received treatment in our department from October,2013 to September,2015,were included in this study.The time between injuries to admission was less than 4 hours of the two groups of patients.And the patients whose hemoglobin was less than 100 g/L were removed when admission,in order to avoid the interference of primary anemia.All information,including height,weight,and the value of hemoglobin (Hb) and hematocrit (Hct),were collected.Blood tests were performed immediately after admission,at daily morning preoperatively,and at the morning of the day of surgery.Preoperative blood loss (hidden hemorrhage) was recorded.With respect to blood loss of hidden hemorrhage,statistical analysis was performed at different times (immediate time after admission,and day 1,2,and 3 postoperatively)in the group of intertrochanteric fracture or in the group of femoral neck fracture,and subsequently performed between the two groups.Results The blood loss in the group of intertrochanteric fracture was 196.3 ml,310.1 ml and 418.3 ml in the 1st day,the 2nd day and the third day after admission.There was a significant difference among different time with respect to blood loss.The blood loss was 39.8 ml,65.7 ml and 82.9 ml in the 1st day,the 2nd day and the third day after admission in the group of femoral neck fracture.There was also a significant difference among different time with respect to blood loss.In experimental group,mean blood loss was 418.3 ml and mean Hb decreased by 23.7 g/L at day 3 postoperatively.In control group,mean blood loss was 82.9 ml and mean Hb decreased by 6.7 g/L at day 3 postoperatively.A significant difference was observed between the two groups.The blood loss in patients with intertrochanteric fracture was higher than that in patients with femoral neck fracture.Conclusion The blood loss was gradually increased in elder patients with intertrochanteric fracture over time.There was a significant difference in different time with respect to blood loss.Moreover,a significant difference was found in blood loss of hidden hemorrhage between intertrochanteric fracture and femoral neck fracture.