Age-related macular degeneration (AMD) causes vision loss mainly due to apoptosis of retinal pigment epithelium cells and subsequent degeneration of photoreceptors.Active and passive smoking can increase the incidence of AMD and the progression risk of advanced AMD, and affect the treatment effect of wet AMD.Smoking can cause choroidal vasoconstriction, increased vascular resistance, vascular endothelial dysfunction, thinned choroid and ganglion cell complexes, resulting in impaired vascular reactivity of choroid and retinal vessels.Nicotine in cigarettes can lead to the overexpression of vascular endothelial growth factor (VEGF), which increases the permeability of vessel and proliferation of endothelial cells, thus induces the formation of choroidal neovascularization (CNV). Smoking can induce oxidative stress leading to oxidative damage, reduce the expression of complement factor H, increase the membrane attack complex, lead to macrophage dysfunction, promote the formation of drusen, and induce the formation of CNV.Therefore, a full and deep understanding of the relationship between smoking and CNV and AMD in controlling the occurrence of AMD and preventing the formation of CNV is of great significance for the early prevention of AMD and the exploration of more effective treatment approaches.

Objective To evaluate the inhibited effects of small interfering RNA targeting Rac1(Rac1-siRNA)on rat retinal neovascularization in retinae.Methods Retinal vein occlusion was indueedby retinal photodynamic medthod in 25 Sprague-Dawley rats.Rae1-siRNA vector DNA was injected intothe vitrous of one eye of those rats(gene intervention group),and empty vector DNA was injected into thefellow eye(blank control group).Rae1-siRNA vector was injected in other 25 SD rats without retinal veinocclusion(blank intervention group).Two weeks after injection,fluorescein isothiocyanate(FITC)-dextran was perfused into the hearts of all the rats,and the retinal wholemount was made to observe theneovascularization.The numbers of endothelial cells which break through the internal limiting membranewere counted after hematoxylin-eosin staining.Resuits A massive of neovascularization and FITCleakage were found in blank control group.Small part of neovaseularization and a little FITC leakage wereobserved in the gene intervention group.Retinal vessels were normal in blank intervention group.Compared with blank contrast group and blank intervention group.the difference of the mean numbers ofendothelial cells which broke through the internal limiting membrane in the gene intervention group wassignificant(F=47.168,P=0.000).Conclusion Racl-siRNA can inhibit retinal neovascularizationinduced by retinal vein occlusion in rats.

ve To explore the effectiveness of non-hazardous treatment of excreta on control of intestinal infectious diseases and parasitosis. Methods The popularization rate of sanitary latrines, the non-hazardous treatment rate of excreta, the prevalance rate of B-class intestinal infectious diseases and infectious rate of worm eggs were sta-tistically analyzed. Results With the increasing popularization rate of sanitary latrine and the non-hazardous treat-ment rate of excreta, the prevalance rates of 3 kinds of intestinal infectious diseases (dysentery, typhoid and hepatitis) decreased from 175.14/100 000 in 1991 to 57.78/100 000 in 2 000 namely decreased 67.01% . The infectious rates of helminth eggs decreased from 76.88% in 1991 to 22.16% in 2000 namely decreased 71.17%. Conclusion Non-hazardous treatment of excreta presented obvious effectiveness on disease prevention, which should be widely popularized in countryside.

Objective To investigate the clinical features of multifocal choroiditis (MC) and guide the diagnosis and treatment. Methods Retrospective analysis of clinical data of 18 MC cases (28 eyes) who were diagnosed through fluorescein angiography (FFA) or indocyanine green angiography (ICGA) and fundus characteristics. Results Multiple round to oval lesions scattered throughout the posterior pole and peripheral areas of ocular fundi of all of the 28 eyes(binocular in 10 and monocular in 8) were found. Active focal lesions of ocular fundi were seen in 8 patients and inactive lesions in 10 patients. active and 10 cases were inactive. Choroidal neovascularization(CNV) in macular area was found in 7 patients. The images of FFA of the legions showed hypofluorescence in the early phase, with late leakage and gradual staining or window is defect in the late phase. Conclusions MC is a rare disease and often misdiagnosed to other disease and FFA helpful in diagnosis.

Objective To observe the clinical features and investigate the method of treatment for vasoproliferative tumors of the retina (VTR). Methods Retrospectively analyzed the clinical data of 17 VTR patients (17 eyes) who had undergone examination of ocular funds, fundus fluorescein angiography (FFA), and B ultra-scanning examination, including 1 treated by photodynamic therapy (PDT) and 7 treated by photocoagulation. Pathological examination and photocoagulation was performed on 1 patient who was found with VTR when undergoing vitrectomy. Results Single or multiple red or yellowish tumor lesions were found in ocular fundi of all of the 17 eyes associated with intraretinal and subretinal exudations (100%), haemorrhages (n=10, 58.82%), retinal detachment (n=5, 29.41%), exudative changes at the macula (n=9, 52.94%), and vitreous haemorrhage (n=1, 5.88%). The lesions located at the inferio-temporal quadrant was found in 8 eyes (47.06%), at the superio-temporal quadrant in 7 (41.18%), and at the inferio- and superio-nasal quadrant in 1 (5.88%), respectively. The result of B ultra-scanning indicated that 16 patients had the lesions on the retina. The result of FFA demonstrated the leakage of the fluorescein of the tumor at the early stage. The tumor became smaller in size of the patient treated by PDT,and in 7 patients undergone photocoagulation, 2 revealed slightly shrunken lesions and 1 less leakage. Conclusions The clinical features of VTR were red or yellowish tumedity lesions in ocular fundi with intraretinal and subretinal exudations. The examination of B ultra-scanning and FFA may help to diagnose VTR. PDT and photocoaguation are effective on controlling the lesion but are of no avail for the improvement of visual acuity.

Objective To compare the efficacy and clinical value of early enteral immunonutrition (EIN) combined with glutamine with early standard formula enteral nutrition (EEN) in patients with severe acute pancreatitis(SAP).Methods Twenty-eight patients with SAP were divided into two groups by random number table.Both groups were fasted,given treatments of anti-infection,gastrointestinal decompression,acidoresistance,spasmolysis,pancreatic enzyme inhibition,reduce the burden on the pancreas insulin,water electrolyte balance and parenteral nutrition upon admission into hospital.Spiral nasointestinal tube was implemented within 72 hours of patients' admission.The 14 cases in the EEN group were given treatment of early standard enteral nutrition by nasojejunal tube.The 14 cases in the EIN group received early enteral immunonutrition (glutamine granules,0.2 g/(kg · d),at least three times oral administration by dissolving in enteral nutritious agent peptison with a small amount of warm water).During the treatment,the dose of glutamine granules was reduced gradually until withdrawal when the patients in the EIN group started normal diet.The changes were observed in patients in terms of APACHE Ⅱ,Ranson score,inflammatory markers,nutritional and immune indicators,while monitoring the first defecation time,ICU care unit stay,total hospital stay,total hospitalization costs,complication rate and mortality data.Results Patients of both groups tolerated early enteral nutrition treatment.Fourteen days after treatment,the value of the immune indicator IgG was significantly higher in the EIN group than in the EEN group((19.14 ± 2.03) g vs.(13.79 ± 3.29) g,P ＜0.05).The first defecation time,ICU care days,total hospital costs were significantly shorter or less in patients in the EIN group than in those in the EEN group (first defecation time:((4.29 ± 1.64) d vs.(5.36 ± 0.84)d,t =2.179 ; ICU care:(2.57 ± 0.85) d vs.(3.64 ± 1.60) d,t =2.213 ; total hospital costs:(343.6 ±35.9)thousand yuan vs.(438.6±94.3) thousand yuan,t =3.518; P ＜0.05).Conclusion It is feasible and safety to implement EIN treatment in patients with severe acute pancreatitis.EIN and EEN could significantly reduce the inflammatory response and improve the nutritional status of patients with severe acute pancreatitis.But EIN is better in improving immune function and the prognosis of patients with severe acute pancreatitis than the EEN.

Objective To study the expression of LRP16 and E-cadherin(E-cad),ER,PR in eutopic endometrium and ectopic endometrium of endometriosis(EM),as well as to study the relation one another and the possible clinical significance.Methods The expression of LRP16 and E-cadherin,ER,PR in endometrium was detected by immunohistochemical two step staining methods in 72 patients with endometriosis which was finally confirmed by laparoscopic operation.Results The expression of LRP16 in epithelioglandular endochylema in eutopic endometrium of EM was significantly higher than that in ectopic endometrium(P

Objective To investigate the efficacy and side effects of aripiprazole combined with modified electroconvulsive therapy (MECT) in the treatment of female refractory schizophrenia.Methods One hundred and five female refractory schizophrenia patients in the Second Affiliated Hospital of Xinxiang Medical University from July 2014 to May 2016 were selected and divided into control group and observation group.Fifty-two patients in the control group were treated with aripiprazole.In the observation group,53 patients were treated with aripiprazole combined with MECT.All the patients were treated for eight weeks.Clinical efficacies were assessed with the positive and negative syndrome syndrome scale (PANSS);Wechsler memory scale (WMS) were used to evaluate the effect of MECT on memory.Adverse drug reactions were evaluated by treatment emergent symptom scale(TESS) before and after treatment in both groups.Results There was no significant difference in PANSS scores between the two groups before treatment (P ＞ 0.05).The positive symptom scores,the general mental pathology scores and the PANSS total scores in the two groups at the end of the second week were significantly lower than before treatment(P ＜ 0.05);at the end of fourth and eighth week of treatment,the negative symptom scores,the positive symptom scores,the general psychopathological scores and the PANSS total scores of the two groups were significantly lower than those before treatment (P ＜ 0.05 or P ＜ 0.01).The positive symptoms,the general psychopathological scores and the PANSS total score in the observation group were significantly lower than those in the control group at the end of fourth week of treatment (P ＜0.05).At the end of the eighth week of treatment,the negative symptom scores,the positive symptom scores,the general psychopathological scores and the PANSS total scores in the observation group were significant lower than those in the control group (P ＜ 0.05).At the end of the eighth week of treatment,the decreasing rates of PANSS score in the observation group and control group were (39.89-8.62) ％ and (31.97-± 8.17) ％,and the total effective rates were 66.67％ and 48.08％,respectively.The decreasing rates of PANSS score and total effective rates in the observation group were higher than those in the control group (P ＜ 0.05).The WMS score of the observation group decreased more significantly at the end of the second week of treatment compared with that before treatment;at the end of the fourth week of treatment,the score of the picture was louer than that before treatment(P ＜ O.05);but there was no significant difference in WMS score between that at the end of the eighth week and before treatment(P ＞ 0.05).There was no significant difference between the two groups in the TESS score and adverse reaction rate (P ＞ 0.05).Conclusion Compared with single application of aripiprazole,MECT combined with aripiprazole can significantly improve effects in treating female refractory schizophrenia and it can not increase the side effects.

ObjetiveTo explore the relationship between the classification of diabetic macular edema(DME) and the stages of the diabetic retinopathy (DR), the diabetic duration and the visual loss.MethodsRetrospectively analyzed the clinical data of fundus fluorescein angiography (FFA) and other related information of 1 521 patients who were diagnosed as DR. Classified DR according to national standard of the diagnosis and classification of DR, and classified DME according to the standard made by the early treatment diabetic retinopathy study research group of United States. The occurrence of DME in DR in each stage and the relationships between DME and the disease course and the vision were analyzed.ResultsIn 1 521 patients, 791 eyes in 468 patients had DME (30.77%), including 361 eyes (45.64%) with focal DME and 430 eyes (54.36%) with diffuse DME. The occurrence of DME was 1.13% in I-stage DR, 7.84%in Ⅱ-stage DR, 41.98% in Ⅲ-stage DR, and 48.93% in Ⅳ-stage DR. Focal and diffuse DME usually occurred at the Ⅲ and Ⅳ stage of DR respectively, with 178 eyes (22.51%) with focal macular edema at the Ⅲ stage of DR, and 249 eyes (31.48%) with diffuse DME at the Ⅳ stage of DR. Patients with DME were hardly found at the Ⅴand Ⅵ stage of DR because of retinal proliferation and vitreous hemorrhage or other complications which made the condition of macula region blurred. The visual acuity of diffuse DME was worse than focal DME. DME often occurred within 10 years in the diabetic duration, and its severity and incidence increased year by year.ConclusionsDME is the main cause of visual impairment of DR. The incidence of DME increased as the course of the DR prolonged. Along with the development of retinopathy, the incidence of DME increased, and the severity of DME aggravated, but the development of DME and its classification can not be brought into definite correspondence or unification with the classification of DR, hence the typing of DME in another individual classification in DR is of course necessary.

Objective To summarize the clinical results and safety of photodynamic therapy (PDT) through 4 years after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods Clinical data of 73 AMD cases (95 eyes) diagnosed through fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT), treated with PDT were reviewed and analyzed in this hospital from June 2000 to June 2004. The changes of best corrected visual acuity (BCVA), fundus pictures, FFA, ICGA and OCT were compared before and after PDT. Follow-up time varied from 3 months to 4 years (mean, 2 years). Results The mean age of 73 patients was 67.8 years old. The BCVA was from (CF/10 cm) to 1.0. At the final follow up, the BCVA was improved (increase≥2 lines) in 39 eyes (41.1%), stabilized (?1 line) in 51 eyes (53.7%) and decreased 2 lines in 5 eyes (5.3%). Fundus hemorrhage and exudation reduced after PDT. FFA and ICGA showed CNV complete closure in 58 eyes (61.05%), partial closure in 6 eyes (6.32%), CNV incomplete closure in 22 eyes (23.16%) and recurrence in 9 eyes (9.47%). After once PDT of 12 eyes with early-stage AMD, the BCVA improved (from 0.6 to 1.5), CNV completely closed, and the OCT showed disappearance of macular edema and neursensory retinal detachment. No CNV recurred in our four years follow-up observation and the BCVA of the patients remained stable. The mean number of PDT treatment was 1.8 per eye in 95 cases. No serious local or systemic complications were encountered. Conclusions Single or multiple sessions of PDT can acheive long-term safety and efficacy. For early-stage AMD patients with minimally classic CNV, PDT can completely make CNV closed and reduce the risk of visual loss.