Objective To explore the anatomy for transethmoidal-sphenoid optic nerve decompression under endoscopy and its significance in operation. Methods Fifteen cases (30 sides) of formalin-fixed adult optic canal specimens were dissected under the microscope. The anatomic characteristics of the optic canal and its adjacent were observed, and the relative parameters were evaluated according to nasal endoscopic approach. Results ①The relationship between the optic carotid triangle(OCT)with the optic canal, the ophthalmic artery, the cavernous sinus and the internal carotid artery were invariable, its present ratio were in 66.7%. ②The mean distance from the front margin of nasal columella floor to medial wall of the orbital opening, middle portion and the cranial opening in the optic canal were (72.79 ± 5.40)mm, (75.85 ± 5.10)mm and (79.34 ± 4.95)mm, respectively, and the elevation angles were (39.45 ± 3.68)°, (37.30±4.24)°and (35.45 ± 4.16)°, respectively. ③The mean thickness of sheath in the medial wall of the orbital opening,middle portion and the cranial opening were (0.70 ± 0. 18)mm, (0.51 ± 0.15)mm and (0.49-0.22)mm,respectively. The difference in thickness between the orbital opening and middle portion, the cranial opening were very remarkable(P ＜ 0.01 ). ④The lateral deviate distance from medial wall of the orbital opening, middle portion and cranial opening to sagittal median plane of cadaveric were 1/2 (12.69 ± 2.73)mm、1/2( 19.61± 3.47)mm and 1/2 (25.79 ± 3.23)mm, respectively. Conclusion OCT is the most reliable anatomic landmark to locate the optic canal, and the key point is at the orbital opening of the optic nerve in the optic nerve decompression. It is secure and feasible to cut the sheath from the place where the medial wall crosses the superior wall of the optic nerve.

Objective To assess the effect of community management of type 2 diabetes mellitus (T2DM)patients with signing on family doctor service in Shanghai.Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017.T2DM patients,who visited the community health service centers more than three times in the last one year, were enrolled in the study.The questionnaire survey was conducted and lab tests were documented.Results A total of 5 078 T2DM patients were enrolled in this study,among whom 2 033 had signed contract service with family doctors(signing group)with a signing rate of 40.8%.Compared to non-signing group,the patients in the signing group were better followed the recommendations of blood glucose control[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)], diet[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)]and physical activity[63.4%(1 295/2 053)vs.34.8%(1 033/2 978)](χ2=356.507, 400.649 and 393.996, P<0.01).The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group[80.2%(1 615/2 053)vs.77.6%(2 272/2 978), χ2=3.894,P<0.05;81.8%(1 679/2 053)vs.74.5%(2 215/2 978),χ2=38.084, P<0.05]. The control rates of GLU,2 h PPG,HbA1c,and blood pressure in signing group were higher than those in non-signing group[40.0%(823/2 053)vs.35.9%(1 069/2 978),47.3%(971/2 053)vs.45.4%(1 352/2 978),35.2%(722/2 053)vs.32.5%(968/2 978), χ2=18.495,5.218, 5.006, all P<0.05].Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low.

Objective To analyze the risk factors of microvascular complications in patients with type 2 diabetes mellitus (T2DM).Methods The demographic and clinical data of 5078 T2DM patients in six communities of Shanghai were collected during September 2014 to April 2015. The risk factors of microvascular complications in T 2DM were analyzed by classification tree model .Results Among 5078 T2DM patients there were 1007 cases of diabetic retinopathy (DR) (21.1%) and 1937 cases of diabetic nephropathy (DN) (38.4%).The classification tree models showed that the risk factors of DR were higher hemoglobin A1C ( HbA1c), fasting blood glucose ( FBG), postprandial blood glucose ( PBG) and triacylglycerol ( TG) levels;longer course of disease and younger age of onset .The model showed that the risk factors of DN were higher HbA1c, FBG, hypertension, PBG, body mass index ( BMI ) and triacylglycerol (TG) levels;and lower high-density lipoprotein (HDL) level.The HbA1c, course of disease and PBG were more closely related to DR and HbA 1c, hypertension and FBG were more closely related to DN.Conclusion HbA1c is the most important risk factor to microvascular complications; FBG and PBG are independent risk factors of microvascular complications;the course of disease and hypertension are risk factors of DR and DN , respectively .

OBJECTIVE: To provide transnasal endoscopic optic canal decompression with the anatomic reference. METHOD: 15 samples of the adult corpse wet specimen (30 sides for the optic canal) were examined under the endoscope to scrutinize the regional anatomy of the optic canal. RESULT: distance between the spina nasalis anterior and the midpoint of optic canal medial wall is (61.02 +/- 5.83) mm, and the angle between spina nasalis anterior and the midpoint of optic canal medial wall is (45.1 +/- 4.81) degrees. The medial wall of optic canal is longest, with an average length of (11.61 +/- 1.58) mm; the lateral wall of optic canal is thickest, and the medial wall thinnest. 10 traumatic blind patient underwent endoscopic optic canal decompression with satisfactory outcome. CONCLUSION The regional anatomy of the optic canal under endoscope is of importance to endoscopic optic canal decompression. Which is microinvasive with direct approach and clear view thus is widely used in clinical practice.
Adolescent ; Adult ; Blindness ; surgery ; Child ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nose ; anatomy & histology ; surgery ; Optic Nerve ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; surgery ; Young Adult