AIM: To evaluate the effects of 23G vs 20G pars plana vitrectomy ( PPV ) combined with internal limiting membrane peeling, phacoemulsification and intraocular lens implantation for macular epiretinal membrane with cataract. ·METHODS: Totally 45 eyes of 45 patients with macular epiretinal membrane and cataract were enrolled in this retrospective non-randomized controlled clinical study. All eyes were treated with PPV combined with internal limiting membrane peeling, phacoemulsification and intraocular lens implantation. There were 20 eyes in 23G PPV group, and 25 eyes in 20G PPV group. The best corrected visual acuity ( BCVA ) , intraocular pressure (IOP), counting of corneal endothelial cells ( CEC) and central retinal thickness ( CRT ) were examined before surgery. BCVA results were converted to the logarithm of the minimum angle of resolution ( LogMAR ) visual acuity. All operations were performed by the same doctor. Operation time for vitrectomy and membrane peeling, average ultrasound energy ( AVE) and effective phacoemulsification time ( EPT ) were recorded. BCVA and CRT were observed postoperatively at 30d and 90d, counting of CEC was observed postoperatively at 90d. IOP was observed postoperatively at 1d and 7d. ·RESULTS:The mean operation time for vitrectomy were 12. 57± 1. 35min in 23G group and 17. 30 ± 1. 19min in 20G group. The difference was statistically significant ( t =-12. 488, P<0. 01). There were no statistical significances in operation time for membrane peeling, AVE and EPT between 23G and 20G groups ( t=-0. 68,-1. 186,-0. 737, P=0. 500, 0. 242,0. 465). On 1d after surgery, IOP in 23G group was lower than that in 20G group, the difference was statistically significant (t= -2. 345, P=0. 024). The BCVA and CRT of the two groups both improved after operations. There were no statistically significant differences between two groups in terms of IOP, BCVA, and CRT ( F = 0. 465, 1. 895, 0. 689; P = 0. 499, 0. 176, 0. 411). IOP, BCVA and CRT were significant statistical different in different time-point within each group ( F=291. 245, 103. 06, 665. 402, P<0. 01 ). Different surgical methods of 23G and 20G had interactive effects on IOP with different time points ( F = 13. 245, P<0. 01 ), but different surgeries had no interactive effects on BCVA and CRT with different time points (F=1. 212, 2. 293;P=0. 283, 0. 129). The counting CEC in 23G group was more than that in 20G group postoperatively at 90d, the difference was statistically significant (t=2. 049, P=0. 048). ·CONCLUSION: The 23G PPV combined with internal limiting membrane peeling, phacoemulsification, intraocular lens implantation for macular epiretinal membrane with cataract is effective. Compared with 20G PPV, 23G PPV has advantages in operation time for vitrectomy and counting CEC. But lower IOP is likely in 23G PPV on 1d after surgery

Objective To explore the establishment of the health management platform through network hospital, and to investigate the effect of the implementation of the continuity health management after discharge on the type 2 diabetes mellitus patients with the use of insulin .Methods Forty-eight type 2 diabetes mellitus patients with the use of insulin received the continuity health management , and individualized education of the use of insulin during the hospital and the continuity health follow-up management through network hospital after discharge.The scores of the compliance , knowledge and injection practice of the use of insulin , the comprehensive ability of management diabetes , and the levels of fasting blood glucose (FBG) and HbA1c were compared in patients 3 months after the intervention .Results The scores of the compliance , knowledge and injection practice of the use of insulin , the comprehensive ability of management diabetes were respectively (7.35 ±0.95), (82.52 ±8.54), (117.47 ±12.42) after the intervention, and were higher than (6.49 ± 1.52), (56.54 ±10.93), (80.86 ±15.71) before the intervention, and the differences were statistically significant (t=4.955 9, 14.003 8, 13.639 6, respectively;P<0.01).The levels of FBG and HbA1c were respectively (6.20 ±0.85) mmol/L, (6.56 ±0.91) % after the intervention, and were lower than (8.53 ± 2.16)mmol/L, (8.73 ±1.72)% before the intervention, and the differences were statistically significant (t=5.985 7,9.003 9, respectively;P <0.01 ) .Conclusions The implementation of the continuity follow-up management through network hospital after discharge in type 2 diabetes mellitus patients with the use of insulin can significantly improve the compliance , knowledge and injection practice of the use of insulin in patients , and establish patients ’ self-management action well so as to help them control glucose .

Objective To investigate the etilolgy of failed pyeloplasty in children and to study the feasibility of redo laparoscopic surgery for recurrent nreterupelvic junction obstruction.Methods The clinical data of 39 patients with recurrent ureteropelvic junction obstruction after the primary pyeloplasty underwent redo laparoscopic surgery were analyzed retrospectively between September 2009 and June 2016 in our institution.There were 31 males and 8 females with a mean age of 66 months,ranged from 4 to 204 months.28 patients had left obstructions and 11 had fight obstructions,who were diagnosed by ultrasonography,MRU,and MAG3 renal scan et a1.Under general anesthesia,we identified that two patients (5.1％) had renal calices strictures,four patients (10.3％) had unsolved disease ureter and anastomotic strictures,two patients (5.1％) had adhesion band and anastomotic strictures,one patient had adhesion band,high ureteropelvic anastomosis and ureter torsion,and 30 (76.9％) patients had anastomotic strictures.Thirty-three patients underwent cdismembered pyeloplasty,five patients underwent onlay appendiculoureteroplasty and one patient underwent ureterocalicostomy.Results All surgeries were successfully completed without conversion.No intraoperative complication was encountered.One patient had persistent,frequent and intolerable flank pain with severe hydronephrosis after surgery,he subsequently underwent nephrectomy.One patient had persistent severe hydronephrosis which was repaired with on-lay appendiculoureteroplasty.One patient had anastomotic adhesion and balloon dilatation was performed with no further obstruction in follow up imaging.The rest of the patients got complete clinical or radiologic resolution.The successive rate was 36 of 39 (92.3％) at a mean follow up of 25 months (ranging 3-60 months).Conclusions Unsolved ureteric pathologies,anastomotic stricture,renal calices stricture,adhesion band,torsion of ureter and high ureteropelvic anastomosis all contribute to recurrent obstruction after the primary pyeloplasty.Laparoscopic redo pyeloplasty is safe and feasible for skilled surgeons.

OBJECTIVE: To observe cardiac ultrastructure and the expression of heat shock protein 70 (HSP70) and hypoxia inducible factor-lα (HIF-lα) in electric shock death rats and to explore the application of these indexes as the basis of medical identification in electric shock death. METHODS: Seventy-two SD rats were randomly divided into electric shock death group, postmortem electric shock group and the control group. The changes of myocardial ultrastructure were observed by transmission electron microscope, and the expressions of myocardial HSP70 and HIF-1α were observed by immunohistochemical technology. RESULTS: Myocardial myofibril fracture, mitochondrial cristae and membrane dissolution, and disordered arrangement of Z lines and M lines were observed in electric shock rats. HSP70 and HIF-lα were strong positive expressions in the electric shock death group, significantly compared with the control and postmortem electric shock groups (P < 0.05). CONCLUSION The expressions of HSP70 and HIF-lα were obviously increased in electric shock death group, which may be used as the diagnostic indicator of electric shock death.
Animals ; Death ; HSP70 Heat-Shock Proteins/metabolism* ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Myocardium/pathology* ; Rats ; Rats, Sprague-Dawley

Objective To investigate the general health status and nutritional knowledge of medical and support staff under 45 at three general hospital so as to provide theoretic basis and implementation suggestion for future health care. Methods Their knowledge of nutrition was compared by a questionnaire;body mass index (BMI), waist circumference, and abnormal physical examination results were investigated and analyzed;correlation of nutritional knowledge and health status was analyzed. Results Both groups had a better understanding of nutrition;the mean score of medical staff was higher than that of support staff, and the difference was statistically significant ( 7.9 ± 0.2 vs 6.6 ± 0.3;t = 2. 18, P ＜ 0. 05 ). Except for abnormal electrocardiogram, the abnormal proportion of other indicators in medical staff was lower than that in support staff on the nutritional status assessment and examination results, and the difference was statistically significant( P ＜0. 05 or P ＜ 0. 01 ). Conclusions Good nutrition knowledge helps to improve physical fitness;hospitals should strengthen the health education to optimize staff' lifestyle. Support staff shall strengthen their health awareness.

Authors raised that staging based strategies and practice of integrative medicine (IM) by combining syndrome typing and disease identification, and choosing suitable measures in accordance with different persons and seasonal conditions after more than ten years' clinical practice and researches. Radical operation as prior (as evil eliminating) and strengthening vital qi in perioerative period are best strategy for promoting rapid rehabilitation of early stage prostate cancer patients. Strengthening body resistance to eliminate evil was used in treating advanced prostate cancer patients. For example, a comprehensive treatment program for hormone-dependent patients was combined with endocrinotherapy and Chinese herbs for synergisic efficacy-enhancing actions. In this way, these patients' quality of life (QOL) were improved and time to castration resistant prostate cancer (CRPC) was delayed, even some patients were clinically cured. There are lack of effective medicines and methods for CRPC patients. Greatly tonifying original qi is mainly used for improving their clinical symptoms and prolonging survivals. Practice has proved staging based strategies and practice of IM has favorable advantages in treating prostate cancer, especially showing prospect in prolonging survival and postponing progression of advanced prostate cancer patients. Besides, it also could provide beneficial considerations and inspiration for combination of syndrome typing and disease identification.
Disease Progression ; Humans ; Male ; Medicine, Chinese Traditional ; Neoplasm Staging ; Prostatic Neoplasms, Castration-Resistant ; diagnosis ; Quality of Life

The in situ gel systems can form gel in situ after administration to achieve sustained release, thus provides a promising strategy for drug delivery systems. The aim of this study was to design and prepare in situ gel systems for the oral delivery of ibuprofen (IBU-ISG) and study its pharmacokinetics in Beagle dogs. The characteristics of the basic material of gellan gum (Kelcogel, Kel) and sodium alginate (Manugel, M) were studied through investigating the complex viscosity of the Kel or M solution with or without different concentrations of calcium ion or sodium citrate to ascertain the amount range of the excipients. The measurement of complex viscosity of the solution (0. 5% Kel and 1% M) with different concentrations of sodium citrate and calcium ion was carried out to select the suitable proportion of calcium ion and sodium citrate. The formulation of binary IBU-ISG was optimized by monitoring the complex viscosity before gelling in vitro release property. The optimized formulation contains 1.0% sodium alginate, 0.5% gellan gum, 0. 21% sodium citrate and 0.056% calcium chloride. A single oral dose of IBU-ISG and reference formulation (IBU suspension) were given to each of the 6 healthy Beagle dogs, ibuprofen in plasma at different sampling times was determined by RP-HPLC. The pharmacokinetics parameters in 6 Beagle dogs were calculated. The Tmax of IBU-ISG and reference formulation were (1.8 +/- 0.6) and (0.4 +/- 0. 1) h. The Cmax values were (29.2 +/- 7.6) and (37.8 +/- 2.2) microg x mL(-1). The T(1/2) were (2.3 +/- 0.5) and (2.0 +/- 0.9) h, and the AUC(0-t) were (131.0 +/- 38.6) and (117.3 +/- 23.1) microg x mL(-1) x h, respectively. The binary IBU-ISG was successfully prepared.
Administration, Oral ; Alginates ; chemistry ; Analgesics, Non-Narcotic ; administration & dosage ; blood ; pharmacokinetics ; Animals ; Area Under Curve ; Calcium Chloride ; chemistry ; Citrates ; chemistry ; Delayed-Action Preparations ; Dogs ; Drug Compounding ; methods ; Drug Delivery Systems ; Excipients ; Female ; Glucuronic Acid ; chemistry ; Hexuronic Acids ; chemistry ; Ibuprofen ; administration & dosage ; blood ; pharmacokinetics ; Male ; Polysaccharides, Bacterial ; chemistry ; Viscosity

The gene (eg1) encoding for novel endoglucanase 1 was cloned previously from Chinese straw mushroom Volvariella volvacea. EG1 has high thermal stability and optimal pH at neutral and shows great potential in textile and paper industry applications. To improve the expression level of EG1 in Pichia pastoris, the increasing copy number of clone, and its high cell density fermentation in 3.2L fermenter for its high-level expression were investigated in this work. By electro-transformation of pPICZalphaB-egl into GS115EG11 integrated with single copy of eg1 gene, A resistant transformant with 3.8 times higher level expression than GS115EG11 was screened from YPDSZ plate containing 2000 microg/mL of Zeocin. The effect of initial cell density, pH and methanol on its expression and biomass accumulation was evaluated in shaking culture. Optimal EG1 production was observed when initial cell density OD600 was 5.0. EG1 production and biomass accumulation did not seem to vary when cells were induced at different pH values. Both of EG1 and cell density were found to increase with higher methanol concentrations, reaching 62.48 IU/mL and 31.7 (OD600) respectively after 120 h induction with 2.0% (V/V) methanol compared to 30.24 IU/mL and 17.79 (OD60) with 0.25% methanol induction. EG1 expression was further increased by 6.4 times higher than shaking culture after 95.5 hours induction with methanol in fed-batch fermentation, so totally 34 times higher than that for GS115EG11 was achieved by screening of high Zeocin resistant clone and high cell density fermentation. The production of EG1 with 543.36IU/mL CMC activity and 8.80mg/mL protein expression was obtained in Pichia pastoris.
Cellulase ; biosynthesis ; genetics ; Cloning, Molecular ; Culture Media ; Electroporation ; Escherichia coli ; genetics ; metabolism ; Fermentation ; Fungal Proteins ; biosynthesis ; genetics ; Pichia ; genetics ; metabolism ; Volvariella ; enzymology ; genetics

BACKGROUND/AIMS: Mesenteric afferent nerves (MANs) play a pivotal role in the visceral-nociceptive perception. Inappropriate activation of MANs may be involved in the pathogenesis of post-infectious irritable bowel syndrome (PI-IBS). However, the underlying mechanisms remain unclear. We assessed the effects of mucosal mediators from different bowel segments of guinea pigs with PI-IBS on MAN firing and the role of mast cells. METHODS: PI-IBS was induced in guinea pigs by Trichinella spiralis infection. Inflammation in terminal ileum, proximal and distal colon was scored with hematoxylin-eosin staining, and mast cell infiltration was assessed with immunofluorescence. We determined the effects of supernatant extracted from the mucosa of different bowel segments of PI-IBS on MANs activity, and assessed the role of mast cells in this process. RESULTS: Eight weeks after infection, intestinal inflammation resolved, whereas mast cell numbers increased significantly in terminal ileum and proximal colon (P < 0.05) compared with findings in controls. Mucosal supernatant from different bowel segments of PI-IBS models, but not from controls, significantly enhanced the frequency of MAN firing (terminal ileum 41.01 +/- 7.60 Hz vs. 26.55 +/- 0.67 Hz, P = 0.001; proximal colon 45.90 +/- 11.20 Hz vs. 30.88 +/- 6.92 Hz, P = 0.002; distal colon 48.25 +/- 9.70 Hz vs. 29.47 +/- 6.13 Hz, P < 0.001). In addition, the excitatory effects were inhibited by mast cell stabilizer Nasmil (terminal ileum, 32.71 +/- 2.52 Hz, P = 0.030; proximal colon, 30.94 +/- 4.44 Hz, P = 0.002; distal colon, 27.15 +/- 5.83 Hz, P < 0.001). CONCLUSIONS: Supernatant from the intestinal mucosa of different bowel segments of PI-IBS models markedly enhanced the MAN firing in a mast cell-dependent manner, indicating that mast cell-mediated MAN activation plays an important role in the pathogenesis of PI-IBS.
Animals ; Colon ; Fires ; Fluorescent Antibody Technique ; Guinea Pigs* ; Hyperalgesia ; Ileum ; Inflammation ; Intestinal Mucosa ; Irritable Bowel Syndrome* ; Mast Cells ; Mucous Membrane ; Trichinella spiralis ; Visceral Afferents