AIM:To explore the possible alteration of refraction and estimate the potential impact of visual quality, investigate the impact of intraocular structure between the simple operation and the combination of phacoemulsification and intraocular lens implantation, and observe the influence among various tamponade materials application.
METHODS: Ultrasound biomicroscopy ( UBM ) and intraocular len ( IOL ) Master were measured for simple vitrectomy patients ( the simple group, 37 eyes ) and vitrectomy combined with cataract surgery patients ( the combined group, 11 eyes ) . Several parameters were measured such as the anterior chamber depth ( ACD ) , angle opening distance ( AOD ) , trabecular iris angle (TIA), axial length (AL), et al . The simple group was further divided into three sub - groups by various tamponade materials in vitreous: silicone oil group, gas group and equilibrium liquid group. All patients were measured including ACD, AOD250, AOD500, TIA500, AL and corneal curvature (K1, K2) parameters preoperatively and 2wk postoperatively.
RESULTS: AOD250, AOD500, TIA500 and AL were decreased 0. 13±0. 21mm, 0. 16±0. 22mm, 8. 68o±9. 72o and 0. 18±0. 24mm ( all P<0. 05 ) respectively in the simple group postoperatively. ACD, AOD250, AOD500, TIA500 and AL in combined group increased 0. 95±0. 54mm, 0. 13±0. 12mm, 0. 22±0. 20mm, 11. 49o±11. 06o, and 0. 45±0.30mm ( all P < 0. 05 ) respectively after operation. Alteration of ACD, AOD250, AOD500, TIA500 and AL were different between simple group and combined group ( P<0. 05). Of data from various tamponade materials sub-groups, ACD, AOD250, AOD500 and TIA500 of the gas group reduced 0. 19±0. 17mm, 0. 14±0. 09mm, 0. 20±0. 12mm, and 12. 02o±6. 64o respectively after operation ( P<0. 05), the AOD250, AOD500, TIA500 and axial length of silicone oil group decreased 0. 19±0. 25mm, 0. 21±0. 26mm, 10. 44o±9. 67oand 0. 23±0. 19mm respectively after operation ( P < 0.05 ) , while equilibrium liquid group had no significant changed in all intraocular structure (P>0. 05). However, neither the corneal thickness nor curvature (K1, K2) were changed postoperatively (P>0. 05).
CONCLUSION:Alteration of anterior segment and axial length in combined group are different from that of the simple group, while the corneal thickness and corneal curvature ( K1, K2 ) are not obviously changed in all groups. Meanwhile, various tamponade materials can also cause different impact on intraocular structure and refraction. In brief, alterations of intraocular structure might cause discrepant refractive changes and potential influence of visual quality.

Objective To evaluate the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in diagnosis of splenic trauma including its grading diagnosis. Methods US and CEUS in 42 patients with splenic trauma confirmed by CT and/or operation were performed during 9.2004-10.2007. All the data were compared and analyzed retrospectively. Results Of 42 patients with splenic trauma, 28 cases were detected and 14 cases were missed on US examination, whereas, 40 cases were detected and only 2 mild cases were missed on CEUS examination. The detection rate of lesions with CEUS was significantly higher than that of US (P<0.001) . Ten cases in grading the injury were underestimated by US, however, none of them were underestimated by CEUS. CEUS had good concordance with CT and/or operation in grading diagnosis of 42 cases except two mild cases. Conclusions CEUS has very good concordance with CT and/or operation in detecting injury and grading the splenic trauma compared with conventional US. CEUS as a new imaging technology has made great advance of ultrasoongraphy in evaluation of splenic trauma including injury grading,and it is very useful in clinical application.

BACKGROUND: Pancreas-kidney transplantation is an effective treatment for diabetes combined with final stage renal disease. However, as the patients suffer diabetes for a long period of time, and cardiovascular system disease is complex, pre- and post-transplantation treatment is very important for successful pancreas-kidney transplantation.OBJECTIVE: To discuss immunosuppressant, coagulant, perioperative and postoperative treatment during pancreas-kidney transplantation to provide some clinical experience for pancreas-kidney transplantation.METHODS: Clinical data of 5 cases undergoing simultaneous pancreas-kidney transplantation in Department of Urinary Surgery, the 309 Hospital of Chinese PLA General Hospital between 2003 and 2008 were retrospectively analyzed to summarize the application of immunosuppressants and anticoagulant drugs and perioperative clinical monitoring focus. RESULTS AND CONCLUSION: There were 5 male patients with an average age of 43 years, and suffered type I diabetes mellitus complicated with final stage renal disease. The preoperative insulin dosage was 1.5-2.4 U/(kg·d). One case had diabetic retinopathy and fundus oculi hemorrhage for many times; two cases showed apparent coronary atherosclerotic heart disease with preoperative cardiac ejection fraction of 52% and 50%. Exocrine of transplanted pancreas had been considered by the intestinal fluid drainage. A total of 3 cases were complete rehabilitation. Of them, 1 case developed acute rejection in the first seven days after operation, but renal function restored with the hormones impact; 1 case had postoperative acute rejection of transplanted duodenum as well as intestinal fistula, eventually, transplanted pancreas was ectomized, but transplanted kidney was preserved; two cases succeeded in restoring and no complications occurred; 1 had postoperative gastrointestinal bleeding and died from multiple organ failure. Simultaneous pancreas-kidney transplantation is the most effective way to treat the diabetes mellitus with terminal nephropathy. Because of complications in the transplanted exocrine pancreas with bladder drainage, it has been replaced by the enteric drainage. Recovery of the transplanted kidney function is important for successful transplantation. After operation, oral FK should be taken when the serum creatinine returned to 300 umol/L. The application of clotting drug is one of the important factors for recovery of transplanted pancreatic function. Jejunostomy is an important therapeutic measure to prevent the reflux of intestinal juice to the transplanted pancreas in perioperative period. In the follow-up period cathartic drugs are recommended to prevent constipation and reduce the occurrence of acute pancreatitis caused by intestinal fluid reflux.

Objective To analyze C4d deposition in the patients with late acute renal allograft rejection,and explore the role of C4d in grafts survival and grafts loss. Methods Thirty-six patients clinical and pathologically diagnosed as having acute rejection more than one year post-transplant were selected. C4d was detected by immunohistochemistry in renal allograft biopsies. The effect of C4d deposition on long-term graft survival was studied. Results Among 36 recipients with late acute renal allograft rejection, 16 cases were positive for C4d (44.4 %) and 20 negative for C4d (55.6 %). Five cases experienced graft loss in C4d positive group (31.3 %), while 6 cases in C4d negative group (30.0%). There was no significant difference in the graft loss rate between C4d-positive group and C4d-negative group. Log-Rank test demonstrated there was no significant difference in graft survival between C4d-positive group and C4d-negative group. The count of the interstitial infiltrated eosinophils in renal allograft was (9.4 + 4.5) and (2.6 + 1.8) respectively in the C4d-positive group and C4dnegative group (P＜0.05). Conclusion C4d deposition in peritubular capillary of the recipients with late acute renal allograft rejection might not be a prognostic marker for graft outcome.

BACKGROUND: Brain death patient is the optimal donator due to the short warm ischemia time, which is conductive to renal function recover following transplantation. However, there are no reports concerning the recovery of renal function in uremia patients following renal transplantation with brain death patients' kidney. OBJECTIVE: To summarize the experience and therapeutic efficacy of renal transplantation using brain death free-donated kidney. METHODS: Six patients with urinsmia underwent renal transplantation with donor kidney of brain death patients from May 2006 to November 2008 at the Organ Transplantation Center, 309~(th) Hospital of Chinese PLA, were selected, including 2 patients receiving kidneys from a brain death patient, 4 patients receiving kidneys from 3 brain death patients. Four recipients received immunosupprsssive regimen of mycophenolate+ciclosporin+steroid, and 2 recipients received mycophenolate+ acrolimus+steroid. The renal function and medicine density were detected regularly, and change of renal function and pathogenetic condition were retrospective analyzed. RESULTS AND CONCLUSION: All 6 patients accepted renal transplantation successfully. The serum creatinine level was obvious descended in 5 patients within a week after transplantation, which meant that the transplanted kidney had begun to work. One patient suffered delayed renal graft function, and returned to normal at 10 days after transplantation. Three patients suffered acute rejection in the first year, and recovered by intravenous glucocorticoid therapy. One patient died after 1 year for pulmonary infection, which accompanied by serum creatinine of 469 pmol/L. The other patients reexamined regularly, and they had good quality of life up to now. The results reveled that renal function recovers in time after transplantation using brain death free-donated kidney, which can ameliorate life quality of patients.

BACKGROUND: Living-donor kidney transplantation is not only associated to prognosis of recipients, but also donors' healthy. Complete medical and psychological assessment should be performed prior to transplantation to ensure the safety of donors. OBJECTIVE: To analyze and summarize the assessment experience of living-relative kidney donors prior to transplantation. METHODS: Totally 77 cases of living-relative kidney donors admitted at Organ Transplantation Center, Second Affiliated Hospital of General Hospital of Chinese PLA between January 2006 and March 2008 were reviewed. Among them, the analysis was carried out respectively according to the live donor nephrectomy guide of the United Kingdom (2005 Edition) before January 20, 2008, and live donor kidney transplantation consensus Boao meeting after January 20, 2008. In common practice, hypertension, diabetes mellitus, cardiovascular system, infectious disease study, age, obesity, proteinuria, renal artery, renal function, receptor for HLA typing and medical ethics, were systematically evaluated. RESULTS AND CONCLUSION: Of the 77 cases of assessed patients, 69 were qualified, successful donors, and completely cured, without complications. Totally 8 cases of non-donors were due to: 2 cases for hypertension combined with end organ damage; 2 for diabetes mellitus; 1 confirmed malignant tumor in kidney-donated surgery; 1 in the activity period of hepatitis B; 1 for resistance from his wife with medical ethics. The average age of donors was 45.3 years old, including and 7 cases above 60 years old, 24 of 50-59 years old, 29 of 30-49 years old, and 9 below 30 years old. There were 39 cases of parent child donation, 1 child parent donation, 19 siblings donation, 7 cases of three generations of collateral serum, and 3 cases of donation between husband and wife. Of successful donors, blood pressure was above 140/90 in 8 cases; Successful donors were without symptoms of myocardial ischemia but 14 cases had consciously ECG ST-T changes; 3 cases had abnormal fasting blood glucose. The successful donors' body mass index (BMI) reached the average of 23.05 kg/m~2, were below 30 kg/m~2; In assessment of infectious diseases, 3 cases were hepatitis B HBs and HBc-positive in a non-activity period, and the antibody titers were below 500 IU/L. In renography, glomerular filtration rate (GFR) was assessed to average (137.3±28.5) mL/min, and no significant statistical difference emerged (P < 0.05). Vascular three-dimensional CT prompted many left renal artery root in 3 cases, accounting for 4% in successful donors, 1 case did not match, accounting for 1%. It demonstrated that the primary purpose of assessment of -living-donor renal transplantation is to ensure that the adaptability, safety and health of donors. In order to avoid the omission of important medical information and unnecessary invasive inspection, as well as reducing the fees of medical assessment, the assessment should be based on the familiar, universally recognized, clinical evidence-based and reasonable procedures and the flexible assessment process.

OBJECTIVE: To generally, regularly, and continuously evaluate single renal function in donors following living renal transplantation, to study functional changes of single kidney, and to analyze clinical feasibility of living renal transplantation. METHODS: A total of 117 living kidney donors had been selected in this study. Following renal transplantation, indicators of creatinine (Cr), glomerular filtration rate (GFR), urine microscopic examination, blood pressure were monitored and followed up so as to generally evaluate the variation of single renal function and health status of living donor. RESULTS: All 117 living donors accepted kidney transplantation successfully. There were untoward events including 2 cases for drug anaphylaxis, 8 cases for microscopic hematuria, 5 cases for proteinuria, 15 cases for urinary tract infection, 3 cases for anxious emotion after operation, and 22 cases for wound pain. The blood pressure was increased in 19 cases and glomerular filtration rate (GFR) was decreased 4-25 mL/min with the average value of (9.4±4.7) mL/min in all cases, but the rates did not exceed the normal level. Nearly all of the cases displayed creatinine rising and 43 cases still had high creatinine level in 2 months after operation. There were no significant differences between creatinine level and sex, and left or right kidney of donor, but creatinine level of patients (> 50 years old) was significantly higher than patients (< 50 years old) (P < 0.01). Indicators of all cases returned the normal value after operation; however, creatinine level of 5 cases was still abnormal (135 μmol/L). CONCLUSION: The function detail could be fluctuated after living donor renal transplantation, or even exceeded the normal value, but the variation did not impact the whole function for the single kidney and influence the holistic health for donor, thus it could be safe and feasible for living donor renal transplantation.

OBJECTIVE:To study the econamics effect of risperidone and quetiapine in treating of schizophrenia.METH ODS:64schizophrenia patients were randomly divided into risperidone group(34cases)and quetiapine group(30cases).The effects were evaluated based on the reduction of scores determined by brief psychiatric rating scale(BPRS);the adverse effects were evaluated by treatment emergent symptom scale(TESS).And then the cost-effectiveness analysis was carried through.RESULTS:The per capita costs for risperidone and quetiapine were3598.85yuan and3778.63yuan respectively;the re-duction of BPRS scores were(36.09?15.52)and(25.03?14.45)respectvely;the respective cost-effect ratio was99.72yuan and150.96yuan;the increment of the cost-effect ratio for the quetiapine group was-16.25compared with the risperidone group.CONCLUSION:Risperidone is more economical than quetiapine in the treatment of schizophrenia.

OBJECTIVE:To analyze the cost-effectiveness of3kinds of Chinese patent drugs in the treatment of insomnia outpatients.METHODS:78outpatients with insomnia were randomly divided into group A,group B and group C,and they were treated with shumian capsule,sweet dream capsule and compound semen ziziphi spinosae capsule,respectively,then,cost-effectiveness analysis was carried out with pharmacoeconomics.RESULTS:The per capita costs(C)for group A,B and C were288.20yuan,163.08yuan and139.22yuan respectively,the reduction in PSQI scores(E 1 )were5.15,8.88and11.84respectively,the effective rates(E 2 )were26%,46%,and64%respectively;The average cost-effect ratios C/E 1 were55.96,18.36,and11.76respectively;C/E 2 were11.08,3.55,and2.18respectively;The increment of the cost-effect ratios?C/?E 1 for group A and B were—22.27and—8.06respectively;?C/?E 2 were—3.92,—1.33respectively,as compared with group C.CONCLUSION:Compound semen ziziphi spinosae capsule is more economical in3drugs in treating insomnia outpatients.

AIMTo study the protective effects of EA against cer ebral ischemia-reperfusion injury. METHODSAcute cerebral ischemia w as produced by the occlusion of bilateral common carotid arteries of mice .The s urvival time in 12 h of the mice was observed, and the mortalities in 2 h, 6 h, 12 h were recorded. Pulsinelli four-vessel occlusion method was used to make ce rebral ischemia-reperfusion model of rats. The EEG and the reappearing time of righting reflex were recorded and the activity of GSH-Px,LDH,NOS in the brain w as tested. Researching the iNOS expression in hippocampiwith immunocytochemistry method and measure the mean optical density. RESULTSEA can decrease the mortalities and prolong the survival t ime in 12 h of the mice. EA can promote the recovery of the EEG and the RR after cerebral ischemia-reperfusion operation in rats and enhance the activities of the GSH-Px LDH, reduce the activity of the NOS. EA also inhibits the expression of iNOS and reduce it's value of mean optical density in hippocampi of the rat s. CONCLUSIONEA has protective effects against cerebral ischemai-r eperfusion injury.