AIM: To observe the therapeutic effect and safety of improved extra panretinal photocoagulation ( E - PRP) in the treatment of high risk proliferative diabetic retinopathy (hsPDR).
METHODS: A total of 88 consecutive cases (102 eyes) with hsPDR were diagnosed by fundus fluorescein angiography(FFA) from February 2011 to December 2014 in our hospital . Fifty two eyes had been treated by improved E - PRP with 532nm frequency - doubled laser. Fifty eyes had been treated by standard PRP. All cases were checked by FFA and fundus photocoagulation every 3mo. Patients with persisting neovascularization or non perfusion area were treated with laser again. All cases were followed up 6-36mo.
RESULTS: The postoperative visual acuity had no statistical difference between two groups ( P > 0. 05). In improved E - PRP group, retinal non perfusion area and neovascularization disappeared in 35 eyes ( 67%). Effective rate was 88%. Six eyes (12%) underwent pars plana vitrectomy because of vitreous hemorrhage, fiberosis and stretched retinal detachment. In standard PRP group, retinal nonperfusion area and neovascularization disappeared in 23 eyes ( 46%). Effective rate was 66%. Seventeen eyes(34%) underwent pars plana vitrectomy because of anterior retina bleeding or vitreous hemorrhage. The rate of neovascularization disappeared and effective rate had statistical difference between two groups (P<0. 05).
CONCLUSION: It is a safe and effective methods to treat hsPDR by improved E-PRP and it was more effective than traditional PRP.

Objective To study the utility of inferior vena cava-collapse index (IVC-CI) for assessing fluid resuscitation for hypovolemic shock in order to look for better echocardiographic markers to assess patients' condition with hypovolemic shock,also to look for optimal guidance for the adjustment of the treatment for these patients.Methods A total of 40 patients with hypovolemic shock admitted to Emergency Department were enrolled for study.All patients were treated with 500 mL normal saline iutravenously as fluid resuscitation.The vital signs and echocardiographic findings before and after the treatment were documented.Comparison of data between pre-treatment and post-treatment was carried out.Results Of 40 patients,there were 23 male and 17 female with average age (50.00 ± 17.71) years.The time consumed for echocardiography examination was (8.68 ± 5.73) min,time required for establishing central line was (29.32 ± 8.06) min.Collapse index of inferior vena cava (IVC-CI) before and after treatment were (0.43 ± 0.16) and (0.38 ± 0.13),respectively.In hypovolemic shock group,the relationship of the peak velocity (Vpeak) of left ventricular outflow between before and after treatment was r =0.75,P =0.001.The relationship of the peak velocity of left ventricular outflow with left ventricular end diastolic volume (LEDV) before treatment was P =0.03 and after treatment was P =0.05.Conclusions (1) Between IVC-CI and the effectiveness of fluid resuscitation,there was no relationship.It was inappropriate to take IVC-CI as a marker for assessment.(2) Vpeak increased apparently after the fluid resuscitation.(3) Vpeak was proved to be associated with LEDV which supported that Vpeak is the indicator of left ventricular contractility.(4) Time consumed for echocardiography examination was shorter than that for establishing the central line in the group.

0.05),while in both groups those were decreased after treatment (P

Objective To estimate reliability of magnetic resonance elastography (MRE) in measuring liver stiffness of volunteers and patients with chronic liver disease and to assess inter-rater consistency.Methods MRE was performed on a 3.0 T scanner in all subjects,including 24 volunteers (control group) and 64 patients with liver disease (chronic liver disease group).Liver stiffness was measured blindly by two raters.The pathological fibrosis score was applied as a standard reference for liver fibrosis in 22 patients.The intraclass correlation coefficient (ICC) was used to evaluate inter-rater reliability.The differences of liver stiffness between two groups were evaluated using non-parametric MannWhitney U test.Spearman analysis was used to analyze the correlation between fibrosis stages and liver stiffness.Results The intraclass correlation coefficient of liver stiffness was perfect (ICC =0.99,P ＜ 0.01)between two raters.There was significant difference of mean stiffness between control group and patient group (U =90.5,P ＜0.01) with(2.35 ±0.34) kPa and(4.17 ± 0.47) kPa,respectively.The correlation between fibrosis stage (3,3,5,5 and 6 patients in fibrosis stage S0,S1,S2,S3 and S4) and stiffness (2.13,3.25,3.82,5.45 and 7.35 kPa) was very strong (r =0.96,P ＜0.01).Conclusion MRE is a reliable and promising tool to measure liver stiffness and to assess liver fibrosis.

Objective To explore the personality characteristics of abused children in order to reduce the incidence of child abuse.Methods Two hundred and ninty five middle school students were investigated with general questionnaire and Eysenck Personality Questionnaire of children. Eighty six students experiencing child abuse (CA) last year as study group and one hundred and ninety six non-abuse children as controls (NCA) were analyzed by means of Eysenck Personality Questionnaire of children.Results The score of neuroticism in CA group was significantly higher than that in the control group (55.62±10.60/52.65±10.98,t=-2.114 P=0.035). The score of lie in CA group was significantly lower than that in control group (42.21±9.87/46.04±9.20,t=3.184 P=0.002). On the impact of different sex, the psychoticism score of male was significantly higher than that in the control group(52.37±11.49/48.04±9.97,t=-2.227 P=0.028), and the lie score was significantly lower than that in control group(41.03±9.18/46.18±8.79,t=3.125 P=0.002).The scores of those in the female were not significant.Conclusions There is a close association between the unstable emotion and child abuse in children, so training emotional self-control and emotional expression of children might be a intervention strategy in the future. In addition, the frequency of lie in children is probably one of factors that determine whether children are abused or not.

Objective To study the clinical significance of end-tidal carbon dioxide partial pressure (PetCO2 ) during cardiopulmonary resuscitation (CPR) and seek the fixed value according which to decide if we should and when to give up.Methods This was a prospective,observational study.A total of 124 patients with cardiac arrest in or out-of-hospital from may 2003 to March 2009 in emergency department of our hospital were selected.All of them had definite etiological factors.Changes of PetCO2 in 124 cardiac arrest patients during CPR were tracked.Results The gender,age,rescue time in seventy-one patients with the return of spontaneous circulation (ROSC) after endotracheal intubation have a significant difference with that in fifty-three patients without ROSC (P ＜0.01 ).The PetCO2 of the survival were higher than that of patients without ROSC or with ROSC,but finally died (P ＜0.01 ).A fixed point 14.4 mmHg of PetCO2 after 20 minutes' CPR can be used as a reference value to guide CPR or predict prognosis.Conclusions Monitoring PetCO2 during CPR has a predictive value on the success of resuscitation.

ObjectiveTo study the technique and therapeutic effect of percutaneous cannulate screw fixation to treat the traumatic diastasis of the pubic symphysis.MethodsFrom February 2003 to December 2010,46 patients (27 men and 19 women,mean age of 34.6 years) with unstable pelvic fractures and diastasis of the pubic symphysis were admitted.All the patients were treated by closed reduction and percutaneous cannulate screw fixation of the symphysis pubis.Then to complete the fixation of posterior ring,by percutaneous screw inserted through the sacroiliac joint or posterior iliac wing.According to Tile's classification,the patients were classified into type B1.1 in 4 cases,B1.2 in 7,B2 in 2,B3 in 2,C1.1 in 7,C1.2 in 7,C1.3 in 10,C2 in 5 and C3 in 2.All patients were performed posterior ring fixation except 4 cases of type B1.1.Anteroposterior,inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities,and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.ResultsThe average operative time was 45 min (range,15-65 min),and the average intraoperative blood loss was 25 ml (range,15-50 ml).Each patient was inserted one screw in the symphysis pubis.Thirty-five patients underwent postoperative pelvic CT scan and 3screws of them penetrated the wall of symphysis pubis.The average follow-up period was 23.5 months (range,5-48 months).In the follow-up period,no infection and displacement were found.The last follow-up result:according to Matta and Tornetta's standard,the result was excellent in 43 cases and good in 3.Among all patients,31 cases (67.39％) had returned to their original works,6 were to give up their original works as complicating injuries; 28 cases had no pain,13 cases had slight pain of the symphysis pubis while to make an effort,5 cases had pain of sacroiliac joint.There were no iatrogenic injury of nerve.ConclusionClosed reduction and percutaneous cannulate screw fixation of the traumatic diastasis of the pubic symphysis is a safe,feasible and easy manipulated method.The operative injuries is small and the clinical outcome is satisfactory.

Objective To investigate the methods of X-ray diagnosis of various displacement of unstable pelvic fracture in three-dimensional space and its instructive significance in closed reduction.Methods A normal adult pelvic specimen was selected and fixed in a wood-frame at supine position after soft tissue rejection and ligament preservation.With the breakage at the unilateral anterior-posterior ring,models of hemipelvic rotation in the transverse and sagittal planes and hemipelvic vertically upward displacement were induced.Anteroposterior radiographs of the pelvic specimen were made and picture archiving and communication system (PACS) was used to measure width of iliac wing,suprainferior diameter of hemipelvis,vertical displacement of iliac crest,acetabulum roof,pubic tubercle and sciatic tuber and area of obturator foramen.Methods of X-ray diagnosis of various displacements of hemipelvis were concluded and applied in treatment of 43 patients with unstable pelvic fractures.Operation time and intraoperative blood loss were recorded.Postoperative images were evaluated by Matta standard.Results Hemipelvic rotation in transverse plane included eversion and inversion.Width of iliac crest was enlarged and area of obturator foramen was shrunk while extroversion ; on the contrary,an opposite result was observed while inversion.Sagittal rotation included pronation and supination.Pubic tubercle had obvious downward shift,iliac crest presented no change or slight upward shift,suprainferior diameter of hemipelvis was lengthened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was shrunk while pronation; on the contrary,pubic tubercle had obvious upward shift,iliac crest presented no change or slight downward shift,suprainferior diameter of hemipelvis was shortened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was enlarged while supination; iliac crest,acetabular roof,pubic tubercle and sciatic tuber presented equidistant upward shift while the hemipelvis displaced upward vertically.Average operation time was 55 minutes (range,15-85 minutes) and intraoperative blood loss was 26 ml (range,10-50 ml).According to Matta standard,pelvic radiography evaluation at postoperative 3 days was excellent in 31 cases and good in 12 cases,with excellent and good rate of 100％.Conclusion Pelvis X-ray films are able to diagnose various three-dimensional displacement of unstable pelvic fractures and guide closed reduction timely and rapidly to achieve satisfactory result.

Objective To compare the results of stroke risk assessment system in patients with non-valvular atrial fibrillation u-sing CHADS2 and CHA2 DS2-VASc .Methods A total of 420 patients with non-valvular atrial fibrillation were evaluated using CHADS2 and CHA2DS2-VASc ,they were divided into three groups according scores :low risk group(scores 0) ,intermediate risk group(scores 1) ,high risk group(scores≥2) .Compare the average scores and the proportions of three groups of two stroke risk as-sessment system .Results The average score of CHA2DS2-VASc was significantly higher than that′s of CHADS2 (2 .41 ± 1 .93 vs . 1 .39 ± 1 .39 ,P<0 .05) .According to scores of CHADS2 ,the proportions of low risk groups were 34 .5% (145/420) ,intermediate risk group were 28 .8% (121/420) ,high risk group were 36 .7% (154/420) .According to scores of CHA2DS2-VASc ,the propor-tions of low risk group were 16 .2% (68/420) ,intermediate risk group were 23 .3% (98/420) ,high risk group were 60 .5% (254/420) .CHA2 DS2-VASc compared with CHADS2 ,the proportion of low-risk group significantly lower than the latter ,the proportion of high-risk groups significantly higher than the latter(P<0 .05) .Conclusion The scores of CHA2DS2-VASc is significantly high-er than that′s of CHADS2 in patients with non-valvular atrial fibrillation ,there are more patients needs anticoagulation using stroke risk assessment system CHA2 DS2-VASc .

Objective The study was to evaluate DWI for quantifying liver fibrosis. Methods A total of 12 volunteers, 47 patients who had chronic HBV or HCV hepatitis and underwent liver biopsy [Scheuer score for fibrosis(S) and inflammation(G)] were enrolled in this study. They were scanned using a 1.5 T MR unit with b value of 0,250,500,750, 1000 s/mm~2. ADCs at b_(250-1000) and b_(500-1000) were the average ADCs of b=250, 500, 750, 1000 s/mm~2 and b=500, 750, 1000 s/mm~2. The studied the correlation between Scbeuer scores and ADC values, and conducted Mann-Whitney U test and Logistic regression to evaluate ADC for prediction of fibrosis scores. Results The average ADCs were (1.41± 0.11),(1.37±0.09), (1.27±0.05), (1.26±0.04), (1.22±0.06) mm~2/s respectively from SO to S4, stage at b=750 s/mm~2 (F=18.31, P<0.01). With the increase of fibrosis score, the average ADC decreased gradually, the two were better negatively correlated at b_(250-1000)(r=-0.727, P<0.01) than other b values. Using b_(750) and the two combined b values, the found significantly lower ADCs in S2 or greater versus S1 or less and in S3 or greater versus S2 or less fibrosis (P<0.01). The best predictor for S2 or greater was b_(750) with the largest AUC of 0.909, sensitivity of 85.7%, and specificity of 100.0% (ADC ≤1.35×10~(-3) mm~2/s). The best predictor for S3 or greater was b_(250-1000) with the largest AUC of 0.864, sensitivity of 69.6%, and specificity of 95.8% (ADC≤1.53×10~(-3) mm~2/s). Conclusion DWI can be a good predictor for scoring liver fibrosis for S2 or S3 stage above, while b_(750) and the combined b values are suitable for evaluation.