Background Glaucoma is primarily characterized by the damage of retinal ganglion cells in the inner layer.Whether the outer retinal layers are involved is controversial.Although the functional abnormality of the outer retinal layers have been determined,structural studies present difierent outcomes.Objective This study measured and compared photoreceptor layer thickness between normal and glaucomatous eyes using spectral domain optical coherence tomography(OCT). Methods A case-control study was designed.The macular area of 38 eyes from 38 normal volunteers and 48 primary open-angle glaucomatous eyes(POAG)were imaged by spectral domain OCT(SD OCT).The outer nuclear layer(ONL)and inner and outer segments(IS/OS)layer thicknesses in fovea and parafovea(1.5 mm from the fovea) were measured by a single masked observer using an image analysis software (SigmaScan Pro version 5.0).Retinal nerve fiber layer(RNFL)thicknesses of the 86 eyes were measured by Stratus OCT.The photoreceptor layer thicknesses between normal and glaucomatous eyes were compared.The correlation of photoreceptor with RNFL thicknesses was evaluated with linear and non-linear regression models. Results The outer nuclear layer(ONL)thickness in the fovea in normal and glaucomatous eyes were 96.7±10.7μm and 103.7±13.3 μm,respectively,with a significant difference(P=0.011).The inner and outer segments(IS/OS)layer thicknesses in the fovea in the two groups were 59.3±5.5 μm and 59.5±5.5μm,respectively,without significant difference(P=0.890).The outer nuclear layer(ONL)thicknesses in the parafovea in normal and glaucomatous eyes were 70.9±14.0μm and 68.7 ±10.7μm,respectively,(P=0.410).The inner and outer segments(IS/OS)layer thicknesses in the parafovea in the two groups were 45.2±6.4 μm and 43.6±5.5μm,respectively(P=0.228).The relationship between ONL and RNFL thickness was best described with a second order polynomial regression model assoeiation(Y=-0.019X2+2.73X+10.34,R2=0.211,P=0.005). Conclusion The foveal ONL thickness is increased in glaucomatous eyes.The alteration of foveal ON L thickness is associated with the severity of the disease.

Background Fundus photography is a traditional method for detecting local retinal nerve fiber layer (RNFL) defects,but the evaluation of its result depends on the observer's experience.The spectral domain optical coherence tomography (OCT) exhibit the defects of RNFL very clearly.Objective This study was to evaluate the diagnosis value and correlation between topographic profiles of localized RNFL defects determined by spectral domain and time domain OCT with fundus photography.Methods Forty-one normal eyes of 41 subjects and 55 eyes of 55 glaucomatous patients with localized,wedge-shaped RNFL defects identified by two glaucoma specialists in fundus photographs were enrolled in the clinical study.The angular location and width of RNFL defects determined on the images of fundus photography,Cirrus HD-OCT and Stratus OCT were analyzed respectively using Pearson's correlation coefficient and linear regression analysis.This study followed the Helsinki declaration and was approved by Ethic Committee of Shenzhen Eye Hospital.Written informed consent was obtained from each individual before the clinical examination.Results Seventy-five RNFL defects were identified in 55 eyes by two glaucoma specialists unanimously with the defect position at superior-temporal and inferior-temporal quadrants.The sensitivity of Cirrus HD-OCT and Stratus OCT to determining RNFL defects were 88.0% and 69.3% respectively and their specificities were 92.7% and 97.6% respectively.The angular locations of RNFL defects by Cirrus HD-OCT and Stratus OCT were highly correlated with those by fundus photography(r=0.993,r=0.992,P＜0.001);while the angular widths of RNFL defects by Cirrus HD-OCT and Stratus OCT were moderately correlated with those by fundus photography(r=0.420,r=0.432,P=0.019,P=0.002).No significant differences were found in the defect width of RNFL between Cirrus HD-OCT or Stratus OCT and fundus photography(Cirrus HD-OCT:P=0.114;Stratus OCT:P=0.074),and significant difference was found in that between Cirrus HD-OCT and Stratus OCT(P=0.002).Conclusion Spectral domain OCT and time domain OCT can localize RNFL defects with high sensitivity and specificity.The measure value of Cirrus HD-OCT and Stratus OCT for RNFL defects shows a good diagnostic agreement with fundus photography.

Background Glaucoma is primarily characterized by the damage of retinal ganglion cells.The macular ganglion cell complex (GCC)thickness can be quantitatively measured using spectral domain optical coherence tomography(SD-OCT). Objective This clinical study was to explore the macular GCC thickness change in primary open-angle glaucoma (POAG) patient with SD-OCT. Methods A serial case-controlled study was designed.A total 101 eyes of 101 POAG patients and 41 normal eyes of 41 age- and refract power-matched normal subjects were cnrolled in the study.POAG patients were assigned to normal perimetry POAG group,early stage POAG group,advanced POAG group and late stage POAG group.Average macular GCC thickness(GCC-Avg),superior GCC thickness(GCC-Sup) and inferior GCC thickness (GCC-Inf)of subjects were measured by SD-OCT and compared among POAG patients and normal controls.Peripapillary retinal nerve fiber layer(RNFL) thickness was measured with time domain OCT(TD-OCT).The correlation between GCC thickness with RNFL thickness or mean deviation(MD) of perimetry were evaluated and analyzed.Informed consent was obtained from each patient prior to entering this study.Results GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the normalperimetry POAG group and early stage POAG group compared with the normal control group (GCC-Avg:t =5.411,10.247,P ＜ 0.01 ; GCC-Sup:t =6.171,9.484,P＜ 0.01 ; GCC-Inf:t =5.281,8.592,P ＜ 0.01 ).Also,GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the advanced POAG group compared with the early stage POAG group ( GCC-Avg:t =4.246,P＜0.01 ; GCC-Sup:t - 2.419,P - 0.019 ; GCC-Inf:t =4.636,P＜0.01 ),and GCC-Avg thickness,GCC-Sup thickness and GCC-Inf thickness were significantly decreased in the late stage POAG group compared with the advanced POAG group (GCC-Avg:t=2.095,P=0.040;GCC-Sup:t=2.756,P＜0.01:GCC-Inf:t =2.018,P =0.040 ).The positive correlations were seen between GCC-Avg thickness,GCC-Sup thickness,GCC-Inf thickness and RNFL-Avg thickness,RNFL-Sup thickness,RNFL-Inf thickness respectively( r =0.802,0.825,0.856,P ＜ 0.01 ).MD value of perimetry was positive correlated with GCC-Avg thickness in POAG patients ( r =0.601,P ＜ 0.01 ). Conclusions SD-OCT can quantitatively measure and differentiate the GCC thickness in POAG patients.The GCC thickness gradually decreases with the development of POAG.There exist a well correlation between visual field defect and RNFL thinning.

Abstract: Objective To investigate the efficacy of capreomycin adjuvant therapy for multidrug-resistant pulmonary tuberculosis (MDR-TB) and its effect on quality of life and immune function. Methods Eighty-eight elderly pulmonary tuberculosis patients admitted to Affiliated Hospital of Hebei University from October 2019 to October 2020 were selected and divided into two groups according to the random number table method. The control group (n=44) used 4-6Am-Mfx（Lfx）-Pto-Cfz-Z-Hhigh-dose-E/5 Mfx（Lfx）-Cfz-Z-E, the research group (n=44) used capreomycin on the basis of the control group. The 6-Minute Walk Test (6MWT) measured value/predicted value and quality of life [36-Item Short Form Health Survey Questionnaire (SF-36)] scores, safety evaluation results, chest CT cavity and lesion absorption rate and sputum culture turned negative were compared between the two groups, and the serum procalcitonin (PCT) expression levels and immune function were detected before and after treatment. Results The 6MWT measured value/predicted value of the research group and control group before the treatment were (0.48±0.11) and (0.64±0.13), which were significantly higher than corresponding (0.51±0.12) and (0.58±0.14) after treatment (t=6.23, 2.520, P<0.05), the measured/expected value of 6MWT increased in both groups after treatment. Compared with the same group before treatment, the SF-36 scores for each dimension increased in both groups after treatment (P<0.01). The expression levels of serum PCT in the research group and control group before the treatment were (0.37±0.09) ng/mL and (0.12±0.03) ng/mL versus (0.36±0.11) ng/mL and (0.21±0.06) ng/mL after treatment (t=17.480, 7.940, P<0.01). Compared with the same group before treatment, serum PCT expression levels decreased in both groups after treatment. Compared with the same group before treatment, CD3+, CD4+ and CD4+/CD8+ were elevated in both groups after treatment (P<0.05 or P<0.01); after treatment, CD3+, CD4+, and CD4+/CD8+ were significantly higher in research group compared to the control group (t=4.21, 8.02, 2.04, P<0.05). The absorption rate of chest CT cavity and lesions and negative rate of sputum culture in the research group were 88.64% (39/44) and 81.82% (36/44), which were significantly higher than corresponding 63.64% (28/44) and 61.36% (27/44) in the control group (P<0.05). Conclusions　Capreomycin can improve the quality of life of MDR-TB patients, extend the 6-minute walking distance, and regulate serum PCT expression levels and immune function, to promote the absorption of chest CT cavity and lesions, and sputum culture to turn negative, and the security is acceptable.

Objective To evaluate the effect of risk management on nursing quality and patient satisfaction in thoracic surgery. Methods We searched randomized controlled trials ( RCTs) related to the risk management of thoracic surgery in VIP database, Chinese National Knowledge Infrastructure ( CNKI ) and Wanfang Data from January 2011 to July 2015. 2 researchers were selected to evaluate the quality of literature and collect information according to the Cochrane system evaluation member handbook 5.1.0, and RevMan 5.2 software was used to analyze the researches that in accordance with quality standards. Results A total of 9 RCTs, 2 224 patients were included in this research. Meta analysis showed that risk managements can significantly prevent and reduce the incidence of nursing adverse events[RR=0.32, 95% CI (0.11, 0.93), Z=2.09,P<0.05]; and improve the patient satisfaction[RR=1.15, 95% CI=(1.12,1.19),Z=8.65,P<0.01]. Conclusions Risk managements can effectively improve the quality of nursing and improve the patient′s satisfaction.

Objective To determine the efficacy ofantiepileptic drugs (AEDs) on prevention of epilepsy after craniocerebral injury. Methods Related articles searched from the databases such as PubMed, Ovid, Springer, VP and CNKI were collected and strictly evaluated; 21 articles were finally selected. Whether pretreatment with AEDs played its role in epilepsy appeared in the early/late stages was discussed with Meta-analysis; the influences of different craniocerebral injury types (resulting from trauma or surgery) on the efficacy of anti-epilepsy prophylaxis, and the mortality rate of the patients performed pretreatment were analyzed with Meta-analysis. Results Pretreatment withAEDs could significantly improve the results (OR=0.66, Z=4.31, P=0.000); pretreatment with AEDs obviously decreased the rate of epilepsy appeared in the early stage (OR=0.48, Z=3.980, P=0.000), but did not statistically decrease the rate of epilepsy appeared in the late stage (OR=1.05, Z=0.310, P=0.760);pretreatment with diphenylhydantoin (OR=0.53) was more effective on epilepsy appeared in the early stage than pretreatment with carbamazepine (OR=0.40). Pretreatment with AEDs was all-effective considering different craniocerebral injury types resulting from trauma (OR=0.48) and surgery (OR=0.69). No significant differences were noted on the mortality rate of patients performed pretreatment and without pretreatment (OR=0.82, Z=0.920, P=0.360). Conclusion The inception rate of epilepsy can be decreased remarkably after anti-epilepsy prophylaxis with AEDs in patients after craniocerebral injury,and diphenylhydantoin has a better effect for epilepsy appeared in the early stage. No reasonable differences between various kinds of AEDs on epilepsy appeared in the late stage are noted. Pretreatment with AEDs enjoys a good result in both post-traumatic brain injury and craniotomy. Pretreatment can not affect the mortality rate of the patients.

Aged ; Blood Glucose ; metabolism ; Diabetes Mellitus ; diagnosis ; Female ; Glucose Tolerance Test ; Humans ; Male ; Middle Aged ; ROC Curve

OBJECTIVETo evaluate image quality (IQ) and radiation exposure of coronary computed tomographic angiography (CTA) with prospectively electrocardiographic (ECG) triggered high-pitch spiral acquisition using dual source CT.

METHODSTotally 75 consecutive patients with a stable heart rate (HR) ≤65 bpm underwent coronary CTA. patients were divided into two groups according to their HR (group A HR≤60 bpm, group B HR >60 bpm to≤65 bpm) . A dual-source CT scanner was used (0.6mm collimation, 0.28s rotation time, 80~100 kV, 370 mAs/rot) . Data acquisition was prospectively ECG-triggered at 60% of the R-R interval with a pitch of 3.4. Images were reconstructed with 75ms temporal resolution, 0.75mm slice thickness and 0.5mm increment. IQ was evaluated using a four-point scale (1=excellent, 4=unevaluable) .

RESULTSThe mean HR and scan time of all patients was (57.2 ± 4.8) bpm and (0.42 ± 0.02) s. Of 1103 coronary artery segments, 934 (84.7%) had an IQ score of 1, 135 (12.2%) score of 2, 18 (1.6%) score of 3,and 16 (1.5%) were rated as unevaluable. There was no significant difference between the two groups in IQ [mean score (1.19 ± 0.52 vs. 1.22 ± 0.55;Z=-1.107,P=0.268) . The rate of evaluable segments showed no significant difference between the two groups (98.5% vs. 98.6%;X2=0.000,P=1.000) . Mean dose-length product of all patients was (67.2 ± 30.4) mGy × cm, mean effective dose was (0.94 ± 0.43) mSv.

CONCLUSIONIn patients with a stable HR of 65 bpm or less, prospectively ECG-triggered high-pitch spiral CT acquisition provides high IQ at low radiation dose.

Aged ; Bradycardia ; diagnostic imaging ; Coronary Angiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Quality Control ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Tomography, Spiral Computed ; methods

Aspergillus fumigatus wild-type phytase has many favorable properties, such as a good thermorstability and a broad pH optimum. However, the specific activity of the enzyme is relative low. A. fumigatus Q23L phytase resulted in a remarkable increase in specific activity around pH4.5 - 7.0, but the pH stability of Q23L was lower than A. fumigatus wild-type phytase. To increase the pH stability of Q23L, the mutant Q23LG272E was constructed by site-directed mutagenesis with PCR. The gene of A. fumigatus wild-type phytase and the mutant genes encoding the Q23LG272E and the Q23L were correctly expressed in Pichia pastoris GS115. Enzymes were purified and their enzymatic properties were determined. The results revealed that the specific activity of the Q23L improved remarkably, which increased from 51 u/mg of the wild type to 109 u/mg at pH5.5. Meanwhile, the pH stability of Q23L, decreased evidently, especially from pH3.0 to pH4.0.The pH stability of Q23LG272E in pH3.0 - 4.5 and pH6.5 - 7.0 has been improved compared with Q23L. The specific activity of Q23LG272E basically maintained at the level of Q23L. Analysis of 3-D structure and sequence similarity were used to reveal the presumable factors influencing the enzymatic properties of Q23LG272E, and discussion for the relationship between structure and function of phytase was given.
6-Phytase ; chemistry ; genetics ; metabolism ; Amino Acid Substitution ; Aspergillus fumigatus ; enzymology ; genetics ; Biocatalysis ; Electrophoresis, Polyacrylamide Gel ; Fungal Proteins ; chemistry ; genetics ; metabolism ; Hydrogen-Ion Concentration ; Models, Molecular ; Mutagenesis, Site-Directed ; Mutant Proteins ; genetics ; metabolism ; Mutation ; Pichia ; genetics ; Polymerase Chain Reaction ; Protein Conformation ; Protein Engineering ; methods ; Recombinant Proteins ; metabolism ; Structure-Activity Relationship ; Substrate Specificity

Aged ; Carotid Artery, Common ; pathology ; Diabetes Mellitus, Type 2 ; metabolism ; pathology ; Female ; Glucose Intolerance ; metabolism ; pathology ; Glucose Tolerance Test ; Humans ; Insulin Resistance ; Male ; Tunica Intima ; pathology