With high incidence and prevalence,high costs and poor outcome.Optimal dietary and nutrition management is an essential part in managing chronic kidney disease (CKD) and is associated with better patient outcome.An appropriate dietary and nutrition management should be based on chronic disease management model,provided by a multidisciplinary team,and implemented continuously with patient education,evaluation and goal-setting,and finally improve patients' clinical outcomes.

Objective To explore the operational indications, preoperative evaluation,operative essentials and clinical prospect of endovascular repair(EVR) for aortic dissection.Methods Twenty-six patients underwent EVR for aortic dissection and all cases were Stanford B dissection.Four patients had two or more tear entries in different sites.Computed tomography angiography(CTA) or digital subtraction angiography(DSA) were used as preoperative evaluation methods.Results The grafts were installed successfully in 26 patients(100%).The patients were followed up for 1 to 18 months after treatment,and there was no endoleaks and organ or limb ischemia in all the patients.Conclusion Endovascular repair was simple,safe and effective in treating aortic dissection and dissecting aneurysm.

Mechanical ventilation is regarded as an effective means of replacing artificial ventilation during cardiopulmonary resuscitation (CPR), and has been widely used in the treatment of cardiac arrest (CA) patients. However, there are still some controversial issues remaining to be settled, such as the assessmentof the effectiveness of mechanical ventilation, the selection of the optimal oxygen concentration (FiO2), tidal volume (VT), respiratory frequency, and mode of ventilation during the CPR process. The pros and cons of positive pressure ventilation are also inconclusive. We reviewed and summarized the related research in recent years, and recommended that the intermittent positive pressure ventilation (IPPV) of volume controlled with small VT (6-7 mL/kg), low ventilation rates (10 times/min), and pure oxygen could be applied during the mechanical ventilation of CPR. The best mechanical ventilation strategy still needs further experimental researches to discover and explore.

Bosentan is a non-selective endothelin receptor antagonist,which plays an important role in the treatment of children with pulmonary arterial hypertension.Bosentan has shown to improve exercise capacity,hemodynamics and reduce pulmonary vascular resistance in pediatric patients.The main adverse effect is less severely comparing with the adult.The combination of bosentan with other drugs can improve the life quality furtherly.Further study of large-scale trials needs focus on the long-effects of bosentan,the ideal period of therapy and the effects of combination therapy in children.

Humans ; Vision Disorders/etiology* ; Visual Acuity

A new class of dendrimer polylysine poly(ethylene glycol)-lipid was designed and synthesized. The cationic polymer liposomes were prepared by the lipid film-extrusion and post-insertion two methods with these dendrimer polylysine poly(ethylene glycol)-lipid and other lipids. The structural properties of obtained cationic polymer liposomes were studied by laser light scattering and fluorescence spectrometer. It was demonstrated that the nano sized liposomes with different density of surface cationic charges can be prepared by either lipid film-extrusion or post-insertion methods, but post-insertion process did not affect drug loading, did not influence drug loading capacity and did not induce liposomal morphology and particle size. The density of positive charge does not affect the size and distribution of different liposomes size and distribution. It was the better choice for manufacture because post-insertion method did not cause early release of drug and size changes. Cell binding experiments show that cationic polymer liposomes, especially dendrimer polymer liposomes had higher local charge density, and therefore have dramatic non specific cell targeting ability.

Objective To investigate the ex pr ession of squamous cell carcinoma antigen (SCC-Ag) and carcinoembryanic antigen (CEA) and its clinical significance in patients with lung cancer. Meth ods The pre-treatment serum from 134 patients with lung cancer from 1998 to 2002 were analyzed for the SCC-Ag level and CEA level by IMX, and the correlation of the SCC-Ag level and CEA level with the clinicopathologic charac teristics were also detected. Results Significant correlations were found between the pre -treatment SCC-Ag level, and CEA level and the pathologic classification, clin ical stage, the positive rate of diagnosing lung cancer was raised by combined a ssay with serum SCC-Ag and CEA. Conclusion Pre-treatment and after-treatment measurement of serum SCC-Ag level and CEA level can be used for diagnosis, prediction of pr ognosis and monitor of after-treatment recurrence in patients with lung cancer.

BACKGROUND:As a traditional treatment for multilevel cervical myelopathy,nterior long-segmental decompression has the shortcomings of great operative trauma,high difficulty,low fusion rate,etc.,which can affect the postoperative efficacy.OBJ ECTIVE:To evaluate the clinical effects of three different anterior surgeries on multilevel cervical myelopathy.DESIGN:A comparative observation.SETTING:Department of Orthopaedics,Changzheog Hospital,the Second Military Medical University of Chinese PLA.PARTICIPANTS:Thirty-six patients with multilevel cervical myelopathy of 3 consecutive segments,who were surgically treated,were selected from the Department of Orthopaedics,Changzheng Hospital,the Second Military Medical University of Chinese PLA from June 1999 to June 2003,including 25 males and 11 females,35-62 years of age,the disease course ranged from 3 to 26 months. According to the clinical manifestations and imaging esults,they were diagnosed as multilevel cervical myelopathy,and they were not suffering from consecutive ossification of posterior longitudinal ligament and ossification of ligamenta flava. Informed contents were obtained from all the patients and their relatives.METHODS:All the patients were grafted with utologous bone. Autologous ilium or cancellous bone excluding vertebral body was filled into titan net or Cage,which were made of titan and characterized by high intensity,tolerance to decay,good biocompatibility,etc. According to the operative manner,the patients were divided into 3 groups:① two-level corpectomy with fusion group(long-segmental decompression group,n =11):There were 4 cases grafted with long-titan net,and 7 cases grafted with autologous iliac bone. Sub-total two-level corpectomy with fusion was performed. ②segmental decompression group(n =16):including 12 cases of titan net+cage graft,4 cases of autologous bone+cage graft. One-level decompression and sub-total single corpectomy with fusion were performed. ③three-level decompression group(n =9):Only discectomy without corpectomy was performed. After complete decompression,3cages were used to fill artificial bone or grafted with autologous bone.MAIN OUTCOME MEASURES:Cervical anteroposterior and lateral radiographies,flexion and extension radiograph were reexamined within 1 week and at 3,6 and 12 months postoperatively. The neurological function was assessed using the Japanese Orthopaedic Association(JOA) scoring method preoperatively and 3 months postoperatively. The total score was 17 points,the higher the score,the better the neurological function. The duration of operation,perioperative bleeding amount,length of stay,cost of hospitalization,graft fusion at 3 months postoperatively,improved JOA score at 3 months postoperatively were recorded in the three groups. The occurrence of postoperative complications was observed by means of return visit.RESULTS:All the 36 patients with multilevel cervical myelopathy were involved in the analysis of results. The mean duration of operation,mean perioperative bleeding amount and mean length of stay in the segmental-decompression group and three-level decompression group were obviously fewer or shorter than those in the long-segmental decompression group(P ＜ 0.05),and the average cost of hospitalization was obviously higher than that in the long-segmental decompression group(P ＜ 0.05). The postoperative improved JOA score and graft fusion rate were close among the groups(P ＞ 0.05).CONCLUSION:Segmental anterior cervical decompression is a recommendable technique for multilevel cervical myelopathy by comprehensively considering the fusion rate,recovery of neurological function,duration of operation,perioperative bleeding and length of stay.

Background Excimer laser corneal refractive surgery is one of the major methods to correct refractive error.Centration of the ablation zone is an important factor that affects visual quality after surgery.The pupil center and its shift is a major factor to determine the ablation center.Therefore further study on pupil centroid shift with illumination level alteration is needed.Objective This study aimed to study the characteristics of the pupillary centroid shift along with the change of pupil size under the different illumination conditions and the possible clinical application of the curve of pupillary centroid shift in exeimer laser corneal refractive surgery.MethodsThe variation of pupil size induced by illumination and the changes of pupil center were measured on 114 moderate myopia eyes of 57 subjects with Astra MaxTM Corneal Topographer.Illumination of placido target and image snap model of the topographer was customized to provide 5 illumination levels as follows:0.8,4.4,18.9,82.3,355.0 Lx.Vectorial analysis was used to graph the change of pupil center related to the Coaxially Sighted Corneal Reflex (CSCR).Raw data is converted to relative value to analyze the pupiilary centroid shift.The mean relative change of the pupil size(△P)and the mean of relative pupillary centroid shift(△C)in the form of percentage were used to attenuate the variation among subjects.The original value of illumination(darkest)is defined as 0％ and maximum value(lightest)was as 100％.Results With the increase of illumination,the shift of the pupil center towards nasal side when pupil constrict was found.The mean change of pupil size under the 5 illumination levels were 0,(1.28 +0.40)mm,(2.34 ±0.53)mm,(3.34+0.54)mm,(4.03 ±0.56)mm respectively,and the △P values was 0％,32％,58％,83％,100％ respectively.The mean of pupil centroid shift under the 5 illumination levels were 0,(78±33)μm,(116±60)μm,(143 ±66)μm,(170±71)μm respectively,and the △C was 0％,46％,68％,84％,100％respectively.There was a linear relation between the relative pupil centroid shift and the relative change of pupil size (r=0.980,P=0.025).The amount of pupil centroid shift has a positive correlation with amplitude of the change of pupil size(r=0.480,P＜0.01).Conclusion Pupil center shifts with the change of pupil size.The linear relation between relative pupil centroid shift and the relative change of pupil size can be applied in eximer laser corneal refractive surgery to improve the visual quality with customized ablation center location.

Background Clinical researches showed that antimicrobial-resistance of bacterium is gradually serious.It is very important to master pathogen distribution and antimicrobial susceptibility after eye surgery.Objective This study was to investigate the distribution and drug sensitivity of pathogenic bacteria from ocular operative infection in 3-year duration to provide a reference for reasonable selection of antibiotics.Methods Sixtyfive positive specimens were obtained from 65 patients due to postoperative infection in Department of Ophthalmology of Shenzhou Hospital and Shengjing Hospital from 2009 January through 2011 December.The pathogenic bacteria were isolated and then the drug sensitivity test of conventional antibiotics was performed.Results Among the 65 ophthalmic specimens,35 strains of Gram-positive bacteria were isolated with the constituent ratio 53.8％,and 15 strains of Gram-negative bacteria accounted for 23.1％.Fungus was found in 15 cases with the constituent ratio 23.1％.Staphylococcus epidermidis accounted for 42.9％ in Gram-positive bacteria,and Pseudomonas aeruginosa accounted for 33.3％ in Gram-negative bacteria.Aspergillus was the main component of fungus,which accounted for 60.0％ of the proportion 3 strains of methicillin-resistant Staphylococcus aureus (MRSA) in 8 strains of Staphylococcus aureus,but no vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcus (VRS) were seen.The in vitro drug sensitivity test showed that the main Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,were sensitive to linezolid,vancomycin,levofloxacin and ciprofloxacin with the sensitive rates ＞50.0％,and these bacteria were lowly sensitive to penicillin and erythromycin with the sensitive rates ≤30.0％.Pseudomonas aeruginosa appeared to be the main Gram-negative bacteria,showing a sensitive rate ≥ 80.0％ to tobramycin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem.Conclusions Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Aspergillus are primary pathogens in ocular infection after operation.Antibiotics such as penicillin,erythromycin,levofloxacin,cefotaxime seem to be relatively high resistant to eye infection.To choose sensitive antibiotics timely and reasonably is a key to the prevention and control of ocular infection after operation.