AIM: To observe the effect and safety of applying mitomycin C ( MMC ) in laser - assisted subepithelial keratomileusis ( LASEK) for extreme high myopia.
●METHODS:LASEK with 0. 02% MMC was performed in 364 eyes of 182 patients with extreme high myopia and spherical equivalent was-9. 0 to-10. 25 D. All the patients were divided into four groups according to the applying time of MMC. The time in Group l was 10s, in GroupⅡwas 25s, in Group Ⅲ was 40s and 55s in Group lV. Uncorrected visual acuity ( UCVA ) , residual refraction, Haze, healing time of corneal epithelium, density and variant index of corneal endothelium was examined in these patients and follow-up 6mo.
●RESULTS:At 6mo after surgery, 76. 3%, 94. 0%, 92. 3%and 93. 8% of the patients in Group l, GroupⅡ, GroupⅢ and Group lV respectively achieved the UCVA better than 15/20. There was significant difference of UCVA between Group l and the other three groups (χ2=19. 610, P=0. 000). Proportion of the residual refraction between ± 0. 5D in Group l (78. 8%) was lower than other groups (95. 2% in Group Ⅱ, 93. 3% in Group Ⅲ, and 92. 7% in GroupⅣ) at 6mo and there was significant difference (χ2=16. 329, P=0. 001). Group l had more Haze statistically than the other three groups at 6mo postoperatively ( Hc=50. 110, P=0. 000). The healing time of cornea epithelium seem to be no statistically difference between each group at 6mo (χ2=11. 611, P>0. 05). MMC had no influence on the density of corneal endothelium in each group postoperatively (P>0. 05), there were 3071. 3±284. 4 cells/mm2 in Group l, 3 105. 6 ± 337. 8 cells/mm2 in Group Ⅱ, 2 986. 3 ± 304. 1cells/mm2 in Group Ⅲ and 3 088. 7 ± 372. 5 cells/mm2 in Group lV respectively. The variant index of corneal endothelium calculated in each group at 6mo after surgery was 24. 72 ± 6. 52, 22. 93 ± 6. 74, 24. 38 ± 6. 63 and 23. 14±7. 22 repectively, compare with that preoperatively there were no statistically differences (P>0. 05).
●CONCLUSION: For extreme high myopia LASEK with 0. 02% MMC is effective and safe. The MMC applying time of 25s in LASEK can effectively reduce Haze after surgery and decrease potential complications.

AlM:To make a analysis of visual quality of iris location guided femtosecond laser assisted in situ keratomi ( LASlK) and iris location guided mechanical sub-bowman keratomileusis ( SBK) for high myopia treatment.METHODS:Femtosecond LASlK ( study group ) was performed in 102 eyes of 51 patients with high myopia and 70 eyes of 35 patients were received mechanical SBK ( control group ) from January to October 2013. The spherical refraction of all the patients was from -6. 00 ~-9. 50D. Best corrected visual acuity ( BCVA ) of the patients was ≥1. 0. Uncorrected visual acuity ( UCVA), BCVA, thickness of cornea flap, contrast sensitivity function ( CSF ) and senior ocular aberration were examined in these patients and follow-up was 1a.RESULTS: At 1a after surgery 94. 1% UCVA in study group reached ≥1. 0 and there was 94. 3% in control group. There was no significant difference between two groups (P>0. 05). Residual refraction of study group was-0. 08±0. 10 D and control group was -0. 10±0. 07 D. There was no significant difference of residual refraction between two groups (P>0. 05). C12 , C8 of senior ocular aberration and RMSH in study group was less than control group, amplification:0.1642±0.0519 and 0.2229±0.0382 (t=8. 077, P<0. 05), while C7 was equal in two groups:0. 1583 ±0.1921 and 0. 1436±0. 1536 (t=0. 556, P>0. 05). C8 was 0. 0950±0. 069 and 0. 1858±0. 095 (t=7. 261, P<0. 05). RMSh was 0. 3711 ± 0. 0847 and 0. 5622 ± 0. 1033 ( t= 12. 801, P<0. 05). CSF was no significant difference between study group and control group (P>0. 05). CONCLUSlON: Femtosecond LASlK and mechanical SBK is effective for high myopia. Compared to mechanical SBK, femtosecond LASlK shows more advantages in the senior ocular aberration and visual quality. The cornea flap is more regular from central to peripheral area with femtosecond laser.

Objective To investigate whether velocity vector imaging (VVI) combined with stress echocardiography could detect potential myocardial impairment of the left ventricle(LV) in diabetic rats.Methods DM rats ( n = 18,administered by STZ at 65 mg/kg) and control rats( n = 12) were performed with VVI and M-mode echocardiography both at rest and after dipyridamole stress 12 weeks later. Twodimensional echocardiographic cine loops and M-mode images of three consecutive beats were obtained from the short-axis views at the mid-LV level. The means of segmental peak systolic velocity(Vs), circumferential strain(εc) ,radial strain(εr), systolic circumferential and radial strain rate (SRc, SRr) and the percent wall thickening (WT% ,derived from M-mode) were obtained. After echocardiograms were performed,the hearts were excised and prepared for HE staining and ultrastructural observations under electron microscopy.Results At rest,only SRc in the DM group was significantly lower than that in the control group( P ＜0.05), the other parameters were statistically comparable between the two groups. After dipyridamole stress,all VVI values in the DM group were significantly lower than those in the control group ( P ＜0.05).However,there was no significant difference in WT% between the two groups either at rest or after dipyridamole stress ( P ＞0.05). Conclusions The VVI parameters combined with dipyridamole stress are more effective in evaluating potential myocardial impairment of the LV walls in diabetic rats. SRc might be more sensitive indices that can be used to detect myocardial impairment at rest.

Objective To investigate the relationship between the expression of MMP-7 in peripher- al blood and esophageal cancer.Methods By using Real time RT-PCR, blood samples from 82 cases with postoperative esophageal cancer were detected.Results 37.8 %(32/82)patients were positive for MMP-7 mRNA expression.MMP-7 mRNA positivity significantly correlated with lymph node metastasis,stage,and hematogeneous metastasis.Recurrent disease was found in 28 of 82 cases. Of 28 patients experiencing re- lapse,15 patients were serially follow-up in every three months.The number positive of MMP-7 mRNA be- fore detection by imaging,at the same time of detection by imaging,and after detection by imaging was 5 cas- es,8 cases and 2 cases respectively.Conclusion Examination of MMP-7 mRNA in peripheral blood during follow-up is useful for early detection of occult recurrence.

Background and purpose:Methylene tetrahydrofolate reductase (MTHFR) plays an important role in metabolism of folate and DNA methylation. This study aimed to investigate the relationship between methylene tetrahydrofolate reductase (MTHFR) C677T polymorphism and chemotherapy side effects in advanced non-small cell lung cancer (NSCLC) patients. Methods:A total of 100 patients with advanced NSCLC conifrmed by pathology were included into this study in Zhejiang Cancer Hospital from Jun. 2007 to May. 2009. All patients received the combined chemotherapy of platinum drug and gemcitabine. MTHFR genotypes were determined by allele-specific-PCR technology. Results:In the 100 cases, genotype frequency of MTHFR C677T T/T, T/C and C/C were 20%, 44%and 36%, respectively. Compared with patients of T/T and T/C genotype, patients of C/C genotype were correlated with decreased rate of thrombocytopenia to chemotherapy (P=0.039). No signiifcant differences were observed concerning gastrointestinal toxicity. Conclusion:MTHFR C677T gene polymorphism can be used to predict the adverse reactions to platinum-based chemotherapy in patients with advanced NSCLC.

Objective To study the expression and significance of metalloproteinase 2(MMP-2)and tisse inhibitor of metalloproteinase(TIMP-2 ) in the degenerative calcific aortic valve.Methods 15 calcific and 10 non-calcific aortic valve acquired through aortic valve replacement.were studied by immunohistochemistry for MMP-2 and TIMP-2.Morphologic changes were observed by light and transmission electron microscopic.Results The expression of MMP-2 and TIMP-2 in calcific group were significantly higher than in non-calcific group(P<0.01).Positive cells were mostly localized subendothelial and the extracellular matrix.Control valves exhibited very weak staining of MMP-2 and TIMP-2 mostly localized in the extracelluar matrix.Various degree of endothelial damage and interstitial calcification were observed.Conculsion The expression of MMP-2 and TIMP-2 may play an important role in the calcific aortic valve.They may be involved not only in matrix degradation but also in matrix remodeling.The mecha-nism of regulation and activation remain to be elucidated.

Objective To investigate whether myocardial contrast echocardiography(MCE)combined with stress echocardiography could detect myocardial microcirculation disturbance of left ventricular(LV)in diabetic rats.Methods MCE were performed at rest and after dipyridamole infusion from parasternal shortaxis views at the papillary muscle level in DM rats(n=18,12 weeks later after STZ administration)and control rats(n=12).Regions of interest(ROI)were positioned with the anterior, lateral, posterior and septum walls.Plateau intensity(PI), initial slope of the curve(β)and time to PI(TTP)were obtained from the curve and myocardial blood flow(MBF)and myocardial flow reserve(MFR)was estimated.After the performance of MCE, myocardium was prepared for γ Well counting with ~(99m)Tc-MIBI and CD31 immunohistochemistry staining.Results There was no significant difference in MBF between the ROI of anterior, lateral, septum walls beyond posterior wall in each group at rest and after stress.MCE values from anterior wall were selected as the indexes for comparisons between the two groups.The PI., MBF and MFR in the DM group were significantly lower than those in the control group at rest and after stress(all P< 0.05).The β in the DM group was significantly lower and TTP was significantly longer after dipyridamole stress(P<0.05).The nuclide intake of myocardial tissue in different walls was similar in the DM group, but theY were all lower than those in the control group(P<0.05).The capillary density decreased significantly in the DM group compared with the control group.Conclusions The PI,β,TTP,MBF and MFR derived from MCE were all sensitive parameters in detecting the microcirculation disturbances in the earlier period of DM.

Objective To evaluate the effects of metabolic factors on the quality of 18F-fluorode oxyglucose (18F-FDG) myocardial metabolic imaging in coronary artery disease (CAD) patients with type 2 diabetes mellitus (T2DM). Methods Seventy CAD patients aged 60 years or over with T2DM were studied with myocardial 18 F-FDG dual isotope simultaneous acquisition (DISA) single photon emission computed tomography (SPECT). Fasting plasma glucose, total triglyceride (TG),total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-eholesterol(LDL-C), insulin, C peptide and glyeosylated hemoglobia (HbAlc) were detected. Insulin resistance and islet β cell function were calculated by using the Homeostasis Model Assessment (HOMA) equation. Results Compared with the bad image quality group (36 cases), patients in the excellent image quality group (34 cases) were younger [with average age of (62.2±8.5) years vs. (67.6±8.3) years, P<0.01] and slimmer [with BMI of (24.7±2.6)kg/m2 vs. (26.1±2.5)kg/m2, P<0.05]. The levels of fasting insulin and C peptide were lower in the excellent image quality group than those in the bad image quality group [with fasting insulin level of 8.3 (5.1～12.4) mIu/L vs. 12.7,(6.1～17.9)mIu/L and C-peptide level of 0.6(0.5～0.9)nmol/L vs. 0.9(0.6～1.2)nmol/L, respectively,both P<0.05]. The HOMA insulin resistant index was reduced in the excellent image group [2.7(1.6～4.0) vs. 4.1(1.7～6.5), P<0.05]. Logistic regression analysis showed that obesity and age≥65 years were independent risk factors for image quality, with OR value of 3.73 (95% CI: 1.12～12.45,P=0.022)and 3.75 (95%CI:0.96～14.6,P=0.058)after adjustment of other metabolic factors. Conclusions Insulin resistance is the main factor that influences the quality of 18F-FDG myocardial metabolic imaging in patients with T2DM. In addition, age≥65 years and obesity are also risk factors for image quality.

Objective To investigate whether myocardial dysfunction and perfusion impairment had happened in diabetes mellitus(DM)rats,and to assess the relationship between them by using myocardial contrast echocardiography(MCE)and velocity vector imaging(VVI).Methods MCE and VVI were performed from the short-axis views of the mid-left ventricular level both at rest and after dipyridamole stress in control rats and DM rafs(12 weeks after induction with streptozotocin).MCE-derived myocardial blood flow(MBF)and myocardial flow reserve(MFR)and VVI-derived circumferential strain rate(SRc)and SRc reserve were obtained.Results SRc(absolute value)and MBF in the DM group were significantly lower than those in the control group at rest(P =0.03 for SRc and P =0.005 for MBF).SRc reserve and MFR in the DM group were significantly lower than those in the control group after dipyridamole stress (P =0.000 for SRc reserve and P =0.014 for MFR).There was no significant correlation between SRc and MBF at rest in the DM group(r =0.189,P =0.453).However,significant negative correlation existed between SRc reserve and MFR(r =-0.658,P =0.003).Conclusions Both myocardial systolic function and perfusion are impaired in DM rats.The decrease of MBF might not be the predominant determinant of myocardial systolic dysfunction at rest.However,the impairment of MFR could be an important contributor to the decrease of myocardial contractile reserve.

ObjectiveThis study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1 -5 brain metastases from non-small cell lung cancer (NSCLC).Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively.Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT + 3DCRT) and WBRT plus stereotactic radiotherapy ( WBRT + SRT) plans were generated.Planning target volume ( PTV ) and organs at risk dose were measured and compared by dose volume histogram.Differences were analyzed in the three techniques by Wilcoxon Z -test.Results D99％ of the shoulder ( D99％-D90％ ) from IMRT were higher than from WBRT +3DCRT and WBRT+SRT in all cases.From D15％ of slope (D90％-D10％) to D5％ of tail (D10％ -D1％ ),IMRT were lower than WBRT + 3DCRT and WBRT + SRT ( Z =- 4.72,P =0.000 and Z =- 4.72,P =0.000).D10％ and D5％ of IMRT were (35.1 ±1.42) Gy and (37.7 ±2.91) Gy,WBRT +3DCRT were (36.5±2.86) Gy and ( 39.1 ± 3.56) Gy ;WBRT + SRT were (36.2 ± 2.57) Gy and ( 38.7 ± 3.67) Gy.IMRT vs WBRT+ 3DCRT and WBRT + SRT were significant ( Z=-3.18,-3.18,P=0.001,0.001 and Z=- 4.11,- 3.02,P =0.000,0.002) in 13 patients with 3 - 5 brain metastases.The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT,WBRT +3DCRT and WBRT + SRT plans,respectively,with a 38.7％ reduction from IMRT to WBRT + SRT (Z =-4.78,-4.78,P =0.000,0.000).The brain doses around metastases were similar in the three techniques with 1 -2 metastases,but IMRT was the best with 3 -5 metastases.ConclusionsIMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases.Only IMRT is the best choice for just sparing the dose around brain metastases among 3 -5 brain metastases.