Objective To investigate the expression and significance of Peripheral blood of Toll-like receptor-4 and cytotoxic T lymphocyte-associated antigen-4 in patients with essential hypertension. Methods We selected 35 patients with hypertension and 20 healthy people.We used flow cytometry to investigate TLR4 expression levels, and ELISA to detect the expression of CTLA-4. Results TLR4 expression in peripheral blood of patients with hypertension was (8.63 ±1.16)%, significantly higher (5.27 ± 1.25)%.The difference was statistically significant (t = 6.16,P < 0.05); CTLA-4 expression in peripheral blood of patients with hypertension was significantly higher (P<0.05); Hypertensive patients with CTLA-4 positive rate and TC, LDL-C was positively correlated (P<0.05); TLR4 and CTLA-4 was positive correlation (r = 0.886,P < 0.05). Conclusions TLR4 and CTLA-4 were high expression in hypertensive patients with hypertension,and related to hypertension.

Abstract:Chronic hepatitis C (CHC) is a global health problem, which is prevalent all over the world. China is a low epidemic area. Hepatitis C virus (HCV) is mainly transmitted through blood, and nowadays, intravenous drug addicts are the key population for the prevention and treatment of hepatitis C. HCV has multiple genotypes and gene subtypes, and the distribution of these genotypes and gene subtypes varies significantly among the regions of the world. Nowadays, the treatment of hepatitis C has entered the era of direct-acting antiviral agents, which have high efficacy and safety in the general population. However, when special populations use direct-acting antiviral agents to treatment hepatitis C, we don't know how its efficacy and safety will be. The special populations include children, adolescents, drug users, HCV/HBV co-infected patients, HCV/HIV co-infected patients, and patients who have comorbidity of HCV and chronic kidney disease. This review will discuss the efficacy and safety of using direct-acting antiviral agents to treat hepatitis C in these special populations.

Objective To guide the fluid resuscitation in patients with severe sepsis and septic shock by monitoring the central venous oxygen saturation(ScvO2),and to improve the rescue success rate and prognosis of patients with sepsis.Methods Based on the standard of ScvO2 of 6h,45 patients with severe sepsis and septic shock were divided into two groups:observation group(n=28) and control group(n=17).The ScvO2,mean arterial pressure(MAP) and central venous pressure(CVP) levels were measured in the two groups after fluid resuscitation,and then the mortality,MAP compliance rate and CVP compliance rate were compared between the two groups.Results Compared with mortality in the control group(52.94%),the mortality in the observation group(14.29%) was significantly lower,the difference was significant (x2=5.927,P=0.015),but after 6h's fluid resuscitation,the MAP and CVP standard number in the two groups did not exist significant difference(x2=1.182,P>0.05).Conclusion ScvO2 with or without reaching the standard level(more than 65%) was positively correlated with the severity of the disease after fluid resuscitation in patients with severe sepsis and septic shock.Therefore,the monitoring of ScvO2 plays an important role in guiding the treatment of fluid resuscitation and judging the prognosis.

AlM: To study an approach to visual acuity correction after intracapsular cataract extraction by phase - ll intraocular lens implantation through the individualized arcuate keratotomy.
METHODS: For demonstration, 48 postoperative patients ( 50 eyes ) receiving the intracapsular cataract extraction were gathered up. Each patient received a scleral tunnel major incision along the radial line of the maximum corneal refractive power determined by a cornea curvimeter, and a arcuate keratotomy was made opposite to the major one; through the major incision an iris-claw intraocular lens is implanted. Each patient was measured for their corneal astigmatism and uncorrected visual acuity before and after the surgery.
RESULTS: The results suggested the average corneal astigmatism before the surgery and that 3d, 1, 3, 6 and 12mo after the surgery as+3. 18±0. 68,-1. 56±0. 73,+0. 87± 0. 51, + 1. 21 ± 0. 70, + 1. 33 ± 0. 68 and + 1. 48 ± 0. 48 respectively. The uncorrected visual acuities 3d, 1, 3, 6 and 12mo after the surgery are 0. 5±0. 38, 0. 56±0. 23, 0. 55± 0. 24, 0. 52±0. 28 and 0. 51±0. 25 respectively.
CONCLUSlON: Phase-ll intraocular lens implantation witharcuate keratotomy is helpful to improve the postoperative visual acuity and reduce preoperative corneal astigmatism after the intracapsular cataract extraction aphakic eyes, lt is also a low-cost surgery, and easy to perform, with minor surgical injuries, particularly available for surgical visual acuity correction of the aphakic eye receiving intracapsular cataract extraction.

Adult ; Female ; Humans ; Kartagener Syndrome

AIM: To study the quality of life in patients with thyroid associated ophthalmopathy in China, to analyze the factors related to the decline of quality of life and to provide evidence for the clinical diagnosis and treatment.

METHODS: Totally 125 patients diagnosed with thyroid associated ophthalmopathy from January 2015 to January 2016 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were included. Clinical data including gender, age, eyelid, conjunctival hyperemia and edema, lacrimal caruncle swelling, degree of proptosis, eyelid retraction volume, vision, diplopia were recorded. TAO-QOL questionnaire were investigated. The content was divided into two dimensions: visual function and appearance. Each dimension contains eight related questions. Final indicators for each dimension was the score. Independent t test, ANOVA and multiple regression analysis were performed using SPSS tactics 22.0 software.

RESULTS: Eighty-eight valid questionnaires were included. The average score of visual function was 72.6±28.3 and that of appearance was 66.8±26.0; 28 cases(28/88)were in active phase while 60 cases(60/88)were in inactive phase. Visual function and appearance scores were 59.4±28.8 and 56.1±26.0 in active group; 78.8±26.1 and 71.8±24.6 in inactive group. Active group has decreased score for both visual function sore and appearance score(P=0.002 and P=0.008). The score of patients with mild TAO(26/88 )was 86.2±17.1 and 82.1±17.8; 70.3±28.3 and 63.3±25.5 for moderate-severe patients(55/88), 41.1±34.6 and 37.6±22.7 for extremely severe patients(7/88). The score of both visual function and appearance in severe group were significantly lower than those in the moderate-severe group(P=0.006 and P=0.007).Compared to mild group, those of moderate-severe group were significantly lower(P=0.012, P=0.001).The visual function score of patients in constant diplopia group were significantly lower than the no diplopia group, horizontal or vertical gaze diplopia and inconstant diplopia group(P<0.001, <0.001, =0.002). By multivariate regression analysis, we found the factors that influence visual function score were visual acuity and diplopia(R²=0.470), and those correlated to appearance score were exophthalmos, retraction and diplopia(R²=0.375).

CONCLUSION: TAO-QoL can be used as a simple and effective tool to evaluate the quality of life in TAO patients. The QoL score is related to disease staging and grading. Thus, shortening the course of active phase, decreasing the degree of diplopia and improving visual acuity are critical ways to improve the quality of life in TAO patients.

Carcinoma, Squamous Cell ; radiotherapy ; Head and Neck Neoplasms ; radiotherapy ; Humans

Objective To evaluate the short-term efficacy of total hip arthroplasty combined with subcutaneous osteotomy in the treatment of CroweⅣ hip dysplasia (DDH).Methods From March 2012 to March 2015,14 patients (16 hips) underwent total hip arthroplasty with femoral distraction osteotomy S-ROM femoral stem prosthesis.And we observed its recent efficacy.Results All patients underwent S-ROM prosthesis.The patients underwent transverse osteotomy of the femoral trochanter.The osteotomy length was 2.0-3.5 cm.The average follow-up time was 19 months.And no complications such as dislocation,vascular nerve injury,deep vein thrombosis and infection were observed during the follow-up.The average Harris scores improved from 42.3 preoperatively to 90.4 postoperatively at 9 months after the operation.The average lengths of preoperative limb shortening and postoperative limb shortening were 6.4 cm and 4.3 cm respectively.The X-ray films showed no dislocation of acetabulum and femoral prosthesis.Bone healing was achieved at 6 months after osteotomy.Conclusion This method could be a good choice for Crowe Ⅳ developmental dysplasia.The short-term efficacy is satisfactory.

ObjectiveTo investigate the role of reducing the door-to-needle time for patients with acute ischemic stroke based on the quality improvement program of PDCA cycle.MethodsConsecutive patients with acute ischemic stroke admitted to hospital were registered prospectively from January 1, 2016 to September 30, 2016.Questionnaires and time tracking method were used to investigate the door-to-needle (DNT) and its influencing factors.PDCA cycle method was used to improve the stroke channel workflow and the changing trend of DNT was analyzed.ResultsA total of 71 patients with acute ischemic stroke were enrolled.After 3 PDCA cycles, DNT (median, interquartile range) from 100.0 min (65.5-127.0 min) reduced to58.0 min (45.5-80.0 min) (Z=11.689, P<0.001), the proportion of the patients with DNT ≤60 min increased from 19.05% to 60.00% (χ2=7.893, P=0.019).Conclusions The quality improvement program of PDCA cycle may effectively reduce the time of DNT in patients with acute ischemic stroke.

Objective To investigate the effects of bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression for patients with severe stroke.Methods 50 patients with severe stroke were selected and divided into two groups by using random number tables,which are the observation group and the control group,with 25 cases in each group.The patients in the observation group were treated with bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression,while the patients in the control group simply received bedside indwelling of nasogastric tube.The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day after admission and trace the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the two groups within 14 days and the situation of the days of mechanical ventilation,the days in ICU and the 30 -day mortality of patients were compared in the two groups.Results The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day in the observation group were superior to those of the control group[The goal -rate of target feeding volume on the 7th day:88% vs.64%,χ2 =3.947,P =0.047;the goal -rate of target feeding volume on the 14th day:80% vs.52%,χ2 =4.367,P =0.037].Meanwhile the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the observation group within 14 days were significantly lower than those in the patients of the control group within 14 days[The gastric retention rate:8% vs.56%(14 /25 ),χ2 =10.784,P =0.001;the reflux rate:0% vs.24%(6 /25),χ2 =4.735,P =0.03;the aspiration rate:8% vs.32%,χ2 =4.500,P =0.034;the incidence of aspiration pneumonia:24% vs.68%,χ2 =9.742,P =0.002].The days of mechanical ventilation and the days in ICU of the patients in the observation group are far less than those of the patients in the control group[The days of mechanical ventilation:(11.16 ±4.86)d vs.(13.72 ±3.67)d,t =-2.101,P =0.041;the days in ICU:(15.36 ±5.66)d vs.(18.72 ±2.99)d,t =-2.625,P =0.012].While there was no significant difference between the two groups on the 30 -day mortality(24% vs.32%,χ2 =0.397,P =0.529).Conclusion The bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression can significantly improve the enteral nutritional goal -rate of target feeding volume for patients with severe stroke and greatly reduce the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia,and limit the days of mechanical ventilation and the days in ICU.Accordingly,it has the value of popularization in the clinical application.