Objective To investigate the clinical effects of high-density micropulse photocoagulation (HD-SDM) combined with intravitreal injection of ranibizumab for diabetic macular edema (DME).Methods Thirty-one patients (31 eyes) with DME were randomly divided into two groups.Group A (15 eyes) received HD-SDM combined with intravitreal injection of ranibizumab.Group B (16 eyes) only received intravitreal injection of ranibizumab.The best corrected visual acuity (BCVA) and central macular thickness (CMT) of the two groups before and after treatment were analyzed,and the annual injection times of the two groups were compared.Results The average annual injection times was 3.67 ± 1.11 in group A,and 9.12 ±2.63 in group B.The difference was significant between the two groups (t =2.05,P ＜ 0.05).There were significant differences in CMT before and after treatment in both groups (all P ＜ 0.05).There was no significant difference in CMT between the two groups(t =1.19,P ＞ 0.05).There were significant differences in BCVA before and after treatment in both groups (all P ＜ 0.05),but there was no significant difference before and after treatment between the two groups(all P ＞ 0.05).Conclusion Both HD-SDM combined with intravitreal injection of ranibizumab and single intravitreal injection of ranlbizumab are effective for DME,but the combining treatment can remarkably decrease the annual injection times and had a good compliance of patients,is a good choice for DME patients.

The article described the characteristics of research teaching and try to adopt a different research teaching methods based on the characteristics of the contents of each chapter of aerospace biodynamics to enhance the effectiveness of military medicine lesson and cultivate innovative thinking ability of students in military schools.

Objective To evaluate the impact of maintenance hemodialysis(MHD) on left ventricular(LV) strains via layer-specific speckle-tracking imaging (LSTI).Methods Twenty-eight MHD patients and 28 matched controls were enrolled in the study.Conventional echocardiography and LSTI were performed on patients before and shortly after one hemodialysis session,as well as on controls.Results LV end-diastolic volume (LVEDV) were markedly reduced after one session of HD [(52.3±22.4)ml/m2 vs (55.0±15.3)ml/m2,P=0.033],but still larger than the control group (47.4±6.4) ml/m2.LV ejection fraction (LVEF) decreased in MHD patients after HD [(62.5±8.1)% vs (64.6±7.3)%,P=0.06],which was similar to those in the control group (66.0±4.2)% and in MHD patient before HD (P=0.391).The three layer circumferential and longitudinal strains decreased in the order of the control group,patients before HD and after HD [CS-endo:(-26.3±3.6)% vs (-22.2±4.7)% vs (-19.2±5.4)%;CS-mid:(-19.0±2.7)% vs (-15.3±3.5)% vs (-13.0±3.8)%;CS-epi:(-11.1±2.3)% vs (-8.0±2.6)% vs (-6.5±2.3)%;LS-endo:(-23.7±3.0)% vs (-18.6±3.6)% vs (-16.4±4.5)%;LS-mid:(-20.9±2.7)% vs (-16.3±3.1)% vs (-14.0±4.1)%;LS-epi:(-18.4±2.4)% vs (-14.1±2.8)% vs (-12.0±3.6)%;all P<0.01],while the synchrony index,standard deviation of times to peak longitudinal strain,increased in these three groups [(3.6±1.0)% vs (6.3±1.5)% vs (7.5±2.2)%,all P<0.01].Linear correlation analysis showed ultrafiltration volume was negatively related with the difference of longitudinal strains before and after HD (difference of LS-endo:r=-0.428,P=0.023;difference of LS-mid:r=-0.423,P=0.025;difference of LS-epi:r=-0.422,P=0.025).Conclusions One session of HD may have injurious effects on LV strains and systolic synchrony.The reduction of ultrafiltration volumes may be helpful to protect cardiomyocytes.

Objective To investigate the effect of rosuvastatin on the morphine tolerance in rats and the underlying mechanism.Methods Forty-eight male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 6 groups (n =8 each):control group (group C),morphine tolerance group (group MT),rosuvastatin control group (group RC),rosuvastatin 0.4 mg/kg group (group R1),rosuvastatin 2.0 mg/kg group (group R2)and rosuvastatin 10.0 mg/kg group (group R3).Morphine tolerance was induced by subcutaneous injection of morphine 10.0 mg/kg at 8:00 and 16:00 everyday for 5 consecutive days.The equal volume of normal saline was given in groups C and RC.Normal saline 10 ml/kg was injected through a gastric tube into stomach everyday at 30 min after subcutaneous injection of normal saline or morphine for 5 consecutive days in groups C and MT.Rosuvastatin 10,0.4,2.0 and 10.0 mg/kg were injected through a gastric tube into stomach everyday at 30 min after subcutaneous injection of normal saline or morphine for 5 consecutive days in groups RC,R1,R2 and R3,respectively.The paw withdrawal latency to nociceptive thermal stimulation was measured 1 day before (T1) and 1 day after morphine tolerance was induced (T2).The percentage of maximal possible effect (MPE) was calculated.The rats were sacrificed after the last measurement of pain threshold and the L5 segment of the spinal cord was removed for determination of the expression of extracellular signal-regulated kinase (ERK) and phosphorylated ERK (p-ERK)(by Western blot) and contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) (by ELISA).Results Compared with group C,MPE was significantly decreased at T2 and the expression of p-ERK and contents of IL-1β and TNF-α were increased in groups MT and R1 (P ＜ 0.05).Compared with group MT,MPE was significantly increased at T2 and the expression of p-ERK and contents of IL-1β and TNF-α were decreased in groups RC,R2 and R3 (P ＜ 0.05).There was no significant difference in the indicators mentioned above between groups R2 and R3,and in the expression of ERK between the six groups (P ＞ 0.05).Conclusion Rosuvastatin can attenuate the morphine tolerance in rats by inhibiting the phosphorylation of ERK and decreasing the level of IL-1β and TNF-α.

Objective To evaluate left ventricular torsion and systolic function of the segment by speckle tracking imaging(STI) and real-time three-dimensional echocardiography(RT-3DE) in patients with heart transplantation. Methods Twenty patients with heart transplantation and twenty subjects with normal left ventricular function were examined by Philips iE33 with a X3-1 probe and GE Vivid 7 with M4S probe.Results There were two subjects(100% ) with clockwise rotation in control group patients, but eight patients (40 % ) with clockwise rotation in heart transplantation group. And heart transplantation group were divided into two sub-groups (group A with counterclockwise rotation and group B with clockwise rotation) based on the direction of rotation. In apical level,the systolic peak of the angle of rotation of anterior septum,posterior wall,inferior wall, posterior septum in group A was less than that of control group( P ＜0.05), all segmental systolic peak of the angle of rotation in group B was reduced compared with control group( P ＜0. 05),however all segmental systolic peak of rate of rotation in group A and group B was not significant different compared with control group ( P ＞0. 05) ,all segmental diastolic peak in early and late of rate of rotation in group B was obviously higher than that in control group and group A ( P ＜0. 05), while all segmental diastolic peak in early and late of rate of rotation in group A was not significant different compared with control group( P ＞0.05). The displacement and the parameter index of 17 segment time to minimal systolic volume in group A and group B were not significant different compared with control group( P ＞0. 05), but left ventricular angle of torsion was decreased in group B compared with control group and group A( P ＜0.05). Conclusions STI and RT-3DE can rapidly evaluate function of left ventricular torsion and function of segmental systole and systolic synchrony in patients with heart transplant.

Objective To investigate the feasibility of ultrasound speckle tracking imaging(STI)in assessing left ventricular(LV)systolic and twist function in patients with heart transplantation.Methods Nine patients with heart transplantation and 10 subjects with normal LV function were examined by GE Vivid 7 with a M3S probe.Eighteen regional peak systolic strain and displacement in longitudinal,radial,circumferential,and 18 regional degree of rotation were measured respectively.Results The segmental regional peak systolic strain and displacement were less than those in subjects with normal LV function(P ＜0.05),but segmental regional degree of rotation was more than that in subjeets with normal LV function (P＜0.05).Conclusions STI may provide a noninvasive,simple and quick tool for evaluation of left ventricular systolic and twist function in patients with heart transplantation.

Objective To evaluate the global and segmental (inflow,body and outflow) systolic functions of right ventricle in end-stage renal failure (ESRF) patients by real-time three-dimensional echocardiography(RT-3DE) and four-dimensional right ventricle quantitative analysis (4D-RVQ) and to reveal the long-term impact of renal insufficiency on right ventricular systolic function.Methods RT-3DE was performed in 48 ESRF patients and 26 healthy individuals (control group).Images were acquired and analysed off-line in TomTec 4D-RVQ station.The parameters of RV global and segmental systolic functions,including RV global and segmental end-diastolic volume (EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF),the time to minimum systolic volume(T-msv) were obtained.All the variables were standardized by body surface area (BSA) or heart rate (HR).Results ① In the ESRF group,EDV,SV and EF of body compartment were significantly higher than those of the controls[EDV:(8.5±3.4)ml/m2 vs (6.4± 1.7)ml/m2,P =0.002;SV:(4.5 ± 1.7)ml/m2 vs (2.7±0.9)ml/m2,P =0.0037;EF:(45.4 ± 11.5)％ vs (41.1 ± 7.1)％,P =0.0489],and so were EDV,SV of inflow compartment [EDV:(19.6± 1.0)ml/m2 vs (16.5±0.9)ml/m2,P =0.0438;SV:(12.3±4.6)ml/m2 vs (10.1±3.2) ml/m2,P =0.0433].②Compared with the control group,the global and segmental T-msv were all delayed obviously in the ESRF group (P ＜ 0.001).③The percentage of SV of body compartment accounting for the global SV significantly increased in the ESRF group [(19.5 ± 7.3)％ vs (15.5 ± 5.5)％,P =0.0222],while that of outflow compartment reduced significantly [(20.3 ± 7.0)％ vs (26.8 ± 8.2)％,P =0.0005].Conclusions The global and segmental systolic functions of right ventricle were impaired in ESRF patients,especially in the body compartment.The RT-3DE and 4D-RVQ are helpful technologies in the evaluation and follow-up of right ventricular systolic function in patients with renal failure.

Objective: To explore the safety and efficacy of left atrial (LA) endocardial vagal denervation catheter ablation for treating the patients with refractory vasovagal syncope (VVS).
Methods: A total of 57 consecutive refractory VVS patients with severe symptom and positive response to head-up tilt test (HUT) were enrolled. There were 22 male at the mean age of (43 ± 13) years. The patients had no response or couldn’t tolerate routine treatment. LA model was re-established by three-dimensional mapping system, 10 patients received high-frequency stimulation technique for ganglionated plexi (GP) ablation and 47 received regional catheter ablation at 5 anatomic sites of GP for LA endocardial vagal denervation treatment. In-operative vagal response including hypotension, sinus bradycardia or asystole were observed, the endpoint of ablation was abolition of evoked vagal relfexes. Periodical follow-up was conducted to record the syncope recurrence and to re-examine ECG and HUT in all patients.
Results: There were 52/57(91.2%) patients had positive vagal response by radiofrequency application and reached the endpoint of ablation; 4 patients couldn’t receive obvious evoked vagal relfexes. During (36 ± 22) months follow-up period, there were 52 (91.2%) cases without syncope recurrence, 11 cases still having palpitation, amaurosis and dizziness as the precursors of syncope while the symptoms were much better then they were before. No complication occurred.
Conclusion: LA endocardial vagal denervation catheter ablation is a safe and effective method for treating the patients with refractory VVS, it may also effectively prevent VVS recurrence.

Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.

Objective To investigate the clinical features and TCD-detected microembolic signals in patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, and to explore the possi?ble underlying mechanisms. Methods A retrospective review was conducted on all clinical, laboratory, radiological and TCD monitoring records from patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, who admitted to the neurology department in our hospital. Results The data from twenty-two cases were finally included in this study. All patients presented with acute-onset localized neurological dysfunction, e.g. hemi?paresis, aphasia, hemiparesthesia, dysarthria, hemianopsia and cortical blindness. Their hypercoagulability related diseas?es included 10 cases of systemic malignancy, 5 moderate to severe hyperhomocystynemia (HCY>50μmol/L), 2 nephrot?ic syndrome, 2 antiphospholipid syndrome, 1 ulcerative colitis, 1 polycythemia vera,1 paroxysmal nocturnal hemoglobin?uria. In 18 cases, the hypercoagulability related diseases were diagnosed after their initial stroke onset. DWI showed mul?tiple disseminated acute cerebral infarcts in non-single arterial territories involving bilateral anterior or anterior plus pos?terior cerebral circulation simultaneously. Foci involved lobar cortex/subcortex of cerebral hemisphere in 22 cases, deep cerebral hemisphere in 12 cases, cerebellum foci in 10 cases,brainstem foci in 2 cases. TCD revealed microembolic sig? nals in ten of 22 patients monitored. Conclusions Patients with multiple acute cerebral infarcts involving non-single arte?rial territories, should be screened for hypercoagulability as in that hypercoagulability and microembolism might be in?volved in the etiology of cerebral infarction.