AIM:To observe the clinical effect of femtosecond laser assisted penetrating keratoplasty.
METHODS: Twenty-four cases ( 24 eyes ) with corneal lesions were performed with femtosecond laser assisted penetrating keratoplasty. Preoperative and postoperative endothelial cell density and visual quality were compared.RESULTS: One week after operation, corneal grafts were clear in 21 eyes (87. 5%), mild cloudy in 3 eyes (12.5%);visual acuity ≥0. 5 in 18 eyes (75. 0%), 0. 2 ~0.4 in 6 eyes ( 25. 0%). After 3mo the mean corneal astigmatism was 2. 16±0. 21D ( range 2. 25 ~ 3. 09D). Compared to conventional penetrating keratoplasty which mean corneal astigmatism was average 3. 67±0. 38D after operation, there was significant difference between two groups ( P< 0. 05 ). There were significant differences between preoperative and postoperative visual acuity and astigmatism (both P<0. 05).
CONCLUSION: Femtosecond laser assisted penetrating corneal transplantation operation can improve patient's visual quality. And compared to traditional penetrating keratoplasty astigmatism decreased significantly, incision can be made in individual shape more precisely and neatly.

Objective To raise the awareness of acute kidney injury (AKI) and improve the level of diagnosis.Methods All the hospitalized adult patients in the Affiliated People's Hospital of Shanxi Medical University from January 2012 to July 2013 were screened.Those patients diagnosed as AKI were retrospectively analyzed in terms of incidence,the rate of missed diagnosis,etiology,distribution and prognosis of AKI.Results (1) The incidence of AKI in the patients was 0.67％ (381/56 835),the ratio of male to female was 1.91 ∶ 1,and the average age was (63.45±16.95) years.(2)There were 321 cases diagnosed as pre-renal AKI (84.25％),42 cases diagnosed as renal AKI (11.02％) and 18 cases diagnosed as post-renal AKI (4.72％).(3)There were 189 cases(49.61％) missed diagnosed among all the screened cases.The rates of missed diagnosis in neurosurgery,general surgery and cardiac surgery department was 62.96％,59.09％ and 50.00％,in cardiology,respiratory and neurology department was 50.00％,50.00％ and 45.45％ respectively.(4) Multivariate Logistic regression analysis showed that hypertension [odds ratio(OR)=1.631],renal replacement therapy(RRT)(OR=23.256) and oliguria history (OR=1.936) were independent risk factors of missed AKI diagnosis.Conclusion The missed diagnosis rate of AKI is high and has certain characteristics in different departments.Hypertension,RRT and oliguria history are independent impact factors of missed AKI diagnosis.

Objective To explore the quality of life (QOL) and its influential factors among patients with 3 major rheumatic diseases. Methods A total of 216 patients with rheumatic diseases (84 patients with systemic lu- pus erythematosus, SLE, 83 with rheumatoid arthritis, RA, and 49 with ankylosing spondylitis, AS) were recruited. The information with regard to their quality of life, sociopsychological factors and the evaluation of disease activity were obtained by using the medical outcomes study short form-36 (SF-36) and clinic documents. Results Patients with rheumatic diseases scored significantly lower with each subscale of SF-36 as compared to those of a healthy popu- lation in China (P

Abstract: Objective　To investigate the clinical characteristics and diagnosis key points of brain abscess caused by Nocardia asiatica, and provide a clinical basis for diagnosing and treating intracranial infection caused by Nocardia. Methods　A case of pulmonary Nocardia asiatica complicated with brain abscess diagnosed at the Second Affiliated Hospital of Hainan Medical University was selected to analyze the clinical manifestations, cerebrospinal fluid characteristics, pulmonary and cranial imaging features, and treatment plan, and to summarize the diagnosis and treatment experience. Results　The patient was an elderly woman with a history of diabetes, dry cough was the first symptom without fever or headache. At the beginning of the course, it was diagnosed as pulmonary infection and tuberculosis in the local hospital, and received conventional antimicrobial and anti-tuberculosis therapies, but showed no improvement. The patient developed progressive limb weakness, followed by consciousness disorders, and coma. Cerebrospinal fluid (CSF) adenosine deaminase and lactate dehydrogenase were not abnormal, CSF pressure, protein and white blood cells were high, mainly with multiple nuclear cells. CSF glucose and chloride were normal in the early stage of the disease, but decreased significantly in the later stage. Metagenomic analysis of cerebrospinal fluid indicated Nocardia asiatica with a specific sequence number of 537. Lung CT showed exudation, abscess, and cavity in the right lung. Skull MRI scan + enhancement suggested multiple scattered abscesses in both cerebral hemispheres. The abscesses were of different sizes and showed ring enhancement, with extensive surrounding edema, and ventricular compression. After treatment with meropenem, linezolid, and compound sulfamethoxazole tablets, the cerebrospinal fluid recovered, and the lesions in the lungs and intracranial structures improved. Conclusions　Brain abscess caused by Nocardia asiatica is similar to the tuberculous brain in clinical symptoms, cerebrospinal fluid examination, craniocerebral imaging, so we should be alert to the possibility of Nocardia infection in patients with diabetes. At the same time, metagenomic testing of the cerebrospinal fluid can help confirm the diagnosis. The mortality and disability rates of brain abscess caused by Nocardia are high. Early diagnosis and treatment can improve the prognosis.

This study is to establish an HPLC-DAD-ELSD method for simultaneous determination of 5 flavones and saponins in Rhizoma Anemarrhenae including neo-mangiferin, mangiferin, timosaponin B II, timosaponin B III and timosaponin A III. Samples were analyzed on a Merck Purospher STAR column(4.6 mm x 250 mm, 5 μm). The mobile phase consisted of acetonitrile( A) and 0. 1% formic acid (B) with gradient elution at a flow rate of 1.0 mL · min(-1). The column temperature was set at 40 °C. The DAD detector wavelength was set at 254 nm. The ELSD conditions were as follows: the nebulizing gas flow rate was 2.0 L · min(-1) and temperature of drift tube was 105 °C. The volume was 10 μL. The five compounds were well separated with good linear correlations. The mean recoveries were between 102.0%-104.0%. This method was quick and reliable which provides a foundation for quality control of R. Anemarrhenae.
Anemarrhena ; chemistry ; Chromatography, High Pressure Liquid ; instrumentation ; methods ; Drugs, Chinese Herbal ; analysis ; Flavones ; analysis ; Rhizome ; chemistry ; Saponins ; analysis

Objective To discuss the combined value of gray-scale ultrasound ( GSUS) and contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant thyroid lesions and to explore the optimal diagnostic point of scoring method .Methods Ultrasound images of 178 thyroid lesions confirmed by pathology were synthetically reviewed by scoring 5 GSUS indicators including shape , orientation, interior echogenicity, halo sign, microcalcification and 6 CEUS indicators including relative arrival time of microbubbles in the periphery and interior, peak periphery and interior echogenicity, peripheral ring-enhancement, and homogeneity of enhancement .One positive indicator scored one point .The optimal diagnostic points and their clinical value were explored according to ROC curves .Results Scores of GSUS, CEUS and the combination of GSUS and CEUS were significantly different (Z =10.188,9.843,10.705,all P <0.001). Areas under ROC curves of GSUS, CEUS and the combination of GSUS and CEUS were 0.936, 0.919 and 0.964, respectively.Three or more positive GSUS indicators of five in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 79.6% and the specificity of 91.2%.Two or more positive CEUS indicators of six in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 91.8% and the specificity of 81.2%.Five or more positive GSUS and CEUS indicators of eleven in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 93.6%and the specificity of 92.3%.The areas under the ROC curve of GSUS and CEUS were 0.936 and 0.919.The area under the ROC curve of the combination of GSUS and CEUS was 0.964, larger than the areas under the GSUS ROC curve and the CEUS ROC curve.Conclusion Ultrasound is valuable in the differential diagnosis of benign and malignant thyroid lesions , and the combination of GSUS and CEUS is the most valuable with 5 points as the optimal diagnostic scoring method .

OBJECTIVE: To study the apoptosis of retina and the expression of c-myc protein in form-deprivation myopia. METHODS: Two-day-old chickens were sutured with right eyelid for 4, 8 and 12 weeks. After measurement of refracation, the eyeballs were observed by light microscope and taken photos. Retinal apoptotic cells were measured by TUNEL staining and flow cytometry. C-myc protein were examined by immunohistochemistry and flow cytometry. RESULTS: Lacquer crack lesions were found in sutured eyes at 12 weeks. Apoptotic cells were observed in retinal outer and inner nuclear layer of the sutured eyes at 12 weeks and obvious peak of apoptosis was observed in sutured eyes at 12 weeks. The expression of c-myc protein was significantly more than control eyes at 8 and 12 weeks. CONCLUSION The apoptosis of retinal was present in form-deprivation myopia with the degeneration of retina. C-myc protein plays an important role in retinal apoptosis of myopia.
Animals ; Animals, Newborn ; Apoptosis ; physiology ; Chickens ; Flow Cytometry ; Myopia ; metabolism ; pathology ; Proto-Oncogene Proteins c-myc ; biosynthesis ; genetics ; Random Allocation ; Retina ; metabolism ; pathology

Objective To investigate diffusion-weighted(DWI)magnetic resonance imaging (MRI) features of the thrombi in patients with cerebral sinus thrombosis(CST),and explore their relation with the recanalization rate alter thrombolytic therapy. Methods The clinical and imaging data were retrospectively analyzed in 14 CST cases,including conventional MRI,FLAIR,DWI and MRV features.The hyperintense signals on DWI at the site ofvenous occlusion were analyzed,and MRV was performed 1-3 months after the thrombolytic therapy to assess the recanalization.The relation between the findings by T1WI,FLAIR and DWI before the thrombolytic therapy and the recanalization rate after the therapy was evaluated.Results Hyperintense signals Was detected in 21 occluded sinuses in 9 patients(41%)with a recellt CVT.Hyperintense signals in the thrombi on the initial MRl were associated with a significantly lowered rate of complete recanalization of the vessel as compared with that among cases without the hyperintense signals(19.0%vs 68.2%,P=0.005). Conclusion The DWI signals of the thrombi in the cerebral venous sinuses can be associated with the progression of the thrombosis,and the presence of hyperintense signals in the occluded cerebral sinuses on the initial DWI may suggest a low rate of sinus recanalization after 1 t0 3 months of thrombolytic therapy.

Objective To investigate and analyze consistency in attitudes toward advance directive and life sustaining treatments between cancer patients and their family members.Methods Totally 242 pairs of cancer patients and family members were involved in the research through convenience sampling from two tertiary hospitals.We investigated consistency in attitudes toward advance directive and life sustaining treatments between cancer patients and their family members using questionnaire of attitudes toward advance directive.Results After explanation of advance directive,51.65％ of cancer patients would like to make advance directive.Most of the family members(89.26％) said they would like to follow patients' wishes if they made advance directive.The consistency in attitudes toward advance directive between cancer patients and their family members were "willing" accounting 48.35％,and "not willing" accounting for 1.65％,with weak consistency(Kappa value was 0.05,P＞0.05).The consistency in attitudes toward life sustaining treatments between cancer patients and their family members were "willing" accounting for 16.94％～38.84％,"not willing" accounting for 1.65％～4.96％,and "never considered" accounting for 9.92％～17.77％,with weak consistency(Kappa value was 0.09-0.18,P＜0.05).Conclusion Cancer patients and their family members show positive attitudes toward advance directive without too many differences.Family members' choices on life sustaining treatments cannot fully represent patients' wishes.

Acute traumatic spinal cord injury (SCI) represents one of the most devastating injuries that afflict the human body. Ascorbic acid ( AA) plays an important role in mammalian central nervous system, especially in SCI. In this study, the change of AA concentration after SCI was investigated by using an on-line electrochemical method integrated with in vivo microdialysis. A microdialysis probe (2 mm in length) was implanted into the spinal cord of an anesthetized rat (Thoracic-10). Microdialysis perfusate (2 μL/ min) was collected in the sample loop of an on-line injector for direct injection onto a glassy carbon electrode which was modified with the heat-treated single-walled carbon nanotubes (SWNTs). Normal ascorbic acid concentration in the extracellular fluids of spinal cords was (26. 17 ± 1. 25) μmol/ L (n =8). The experimental spinal cord injury, induced by a lesion at T-10, significantly increased the extracellular ascorbic acid levels to (53. 24± 1. 95) μmol/ L (n =8). This study provides the experimental evidence on the essential roles of ascorbic acid in spinal cord injuries.