This paper introduces the feature of binocular indirect ophthalmoscope and its application in ophthalmologic examination and operation. Compared with direct ophthalmoscope, binocular indirect ophthalmoscope has many special advantages owing to its unique illumination system and principle of formation of image. Most of ocular fundus diseases can be diagnosed correctly by binocular indirect ophthalmoscope. The view is that the inspection technique of binocular indirect ophthalmoscope is the most convenient and predominant in fundus examination, ophthalmology operation and treatment until now, and is of value in use.

Objective To explore the correlation between verbal memory and working memory in patients with alcohol dependence (AD).Methods A total of 40 patients with AD and 40 health controls were included in this study.N-back task was used to evaluate the verbal working memory.20 sets of phrases were used to evaluate long-term verbal memory.Results Correct number of verbal memory in AD group ((5.15±0.92)times) was lower than that of HC group ((7.35±3.07) times) after one-week baseline test,and the difference was statistically significant (t=4.344,P＜ 0.01).Compared with HC group ((1 436.37±192.50) ms,(1.08±0.89) times,(4.00±0.85) times,respectively),AD group((1 535.40± 192.50) ms,(1.90± 1.57)times,(2.60± 1.39)times) showed significantly impaired reply reaction time of 2-back,error number of 1-back and 2-back (t=-2.112,P=0.038;t=-2.899,P=0.005;t=-5.433,P＜0.01).The error number of 2-back task in AD group was negative correlated with verbal memory after one-week baseline test (r=-0.427,P=0.006).Conclusion The verbal memory is impaired in AD patients.Long-term verbal memory damage have a certain correlation with working memory.

Objective To study the effect of perioperative psychological nursing on living-related liver transplantation. Methods The following measures were adopted according to the donors' concrete condition: using nursing procedure in holistic nursing, to assess and determine the main problems in perioperative period, nurses mastered psychological nursing knowledge and skills in individualized psychological nursing, giving pertinent and individualized health education to patients in accordance with their psychological problems during the perioperative period. Results The donors could face the operation with good psychological state after being given fully-integrated and whole-system psychological nursing. Conclusions Psychological nursing is important for living-related liver transplantation during the perioperative period.

Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation,which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor's duodenum and bladder anastomotic artery hemorrhage.Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis.Abdominal infection occurred in 8 cases: one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications (14 operations). The re-operation rate was 25 %, including 2 patients (4 operations) for hematuria, 4 patients for abdominal hemorrhage, 2 patients (3 operations) for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics with endstage renal disease, surgical complication is still affecting the pancreas and kidney grafts after transplantation.

Objective To investigate the effect of globular adiponectin on the high expression of monocyte chemotactic protein-1 (MCP-1) induced by high glucose in rat renal tubular epithelial cells (NRK52E),and its relationship with adiponectin receptors and p38MAPK.Methods NRK52E cells were cultured in vitro and divided into six groups:normal glucose group (NG,5.6 mmol/L glucose),high glucose group(HG,25 mmol/L glucose),gAd groupl (HG+gAd 2 mg/L),gAd group2 (HG+gAd 5 mg/L),gAd group3 (HG+gAd 10 mg/L),p38MAPK antagonist group:(SB,HG+SB203580 10 μmol/L).The protein expression of phosphorylated p38MAPK (p-p38MAPK),total p38MAPK (t-p38MAPK),MCP-1 and AdipoR1/AdipoR2 were examined by western blotting.The mRNA expression of MCP-1 and AdipoR1/AdipoR2 were detected by RT-PCR and real-time PCR respectively.Results Compared with NG group,the mRNA and protein expression of MCP-1 increased significantly in HG group (all P＜ 0.05).The phosphorylation of p38MAPK increased (P＜ 0.05) with no change in t-p38MAPK protein.The addition of gAd or SB203580 inhibited the unregulation of MCP-1 and p-p38MAPK induced by HG.Two kinds of adipoR,adipoR1 and adipoR2,were all detectable in NG group,and mRNA and protein expression of adipoR1 was higher than that of adipoR2 (P＜ 0.01).Compared with NG group,the expression of adipoR decreased in HG group,but the difference had no statistical significance(P ＞ 0.05).Compared to HG group,the mRNA and protein expression of adipoR1 increased in gAd groups (all P ＜ 0.01).Conclusion The gAd can dose-dependently attenuate the overexpression of MCP-1 induced by high glucose,and this protective effect may be mediated by adipoR1 and p38MAPK.

Objective To evaluate the value of monitoring serum cystatin C in assessment of renal function in patients with renal transplantation.Methods Serum cystatin C, creatinine (SCr), β2-microproglobin (β2-MG) and urea nitrogen (BUN) levels were determined at different time points (pre- or post-operation) in 58 renal transplant patients.Glomerular filtrated rate (GFR) was determined by using of 99mTc-DTPA at the seventh day after operation.The correlation between GFR and the four markers was analyzed.Diagnostic characteristics and ROC curve for the four markers were obtained using a GFR cut-off of 1.5 ml/s.Intra-individual coefficients of variation (CV) for cystatin C and SCr according to different time points during post-operation monitoring and the ratio (R) between CVSCr and CVcystatin C were calculated.Results Cystatin C was decreased by 48.1 % at the first day after operation, which was higher than others.The correlation coefficients between GFR and cystatin C, SCr, β2-MG, and BUN were 0.876, 0.691, 0.589, 0.516 respectively.Diagnostic characteristics for GFR and cystatin C, SCr, β2-MG, and BUN were as follows:sensitivity (91.3 %, 87.2 %, 82.6 %, 87.0 %); specificity (80.0 %, 69.2 %, 71.4 %, 42.9 %), positive predictive value (82.0 %, 73.7 %, 74.3 %, 60.4 %); positive likelihood rate (4.81, 2.83, 2.87, 1.53).The area under the curve (AUC) for GFR and cystatin C, SCr, β2-MG, and BUN was 0.914, 0.828, 0.803, and 0.765 respectively.The CVSCr was significantly lower than CVcystatin C (P＜ 0.01).R was less than 1 in most patients with cystatin C＜2 mg/L.In patients with cystatin C＞2 mg/L, R tended value 1 with increasing concentrations of cystatin C.Conclusion Cystatin C showes the best correlation to GFR, and is superior to the other markers in accurate in differentiate mild renal impairment from moderate and severe renal impairment.When renal function has minimal change, the cystatin C level has significant change.When the renal function has mild impairment, great changes in serum cystatin C indicate the unstable renal function.

Aim To investigate the roles of p53-dependent signaling pathways in the process of ginsenoside Rg1 protection against 8-methoxypsoralen(8-MOP) and subsequent ultraviolet A(UVA) irradiation induced photoaging model in human dermal fibroblasts(HDFs).Methods Photoaging model was established by 8-MOP/UVA in skin HDFs.Flow cytometry, enzyme cytochemistry, immunofluorescence and Western blot were employed.Results Pretreatment with ginsenoside Rg1 could significantly reduce the amount of UVA-generated 8-oxo-dG and relieve the photoaging representation.Compared with 8-MOP/UVA treatment group, pretreatment with Ginsenoside Rg1 could decrease the expression of SA β-galatosides(SA-β-Gal), and down-regulate the level of senescence associated proteins(p16 and p21).Conclusions Ginsenoside Rg1 has prominent dose-dependent antagonism on senescence of skin HDFs induced by 8-MOP/UVA, and its mechanism may be due to its antioxidation which reduces the production of photoproducts to protect telomere against abnormal shortening.

Objective To study the predictive value of heart-type fatty acid-binding protein (H-FABP) in the improvement of survival rate in patients with severe sepsis.Methods There was a prospective case-control study in 50 patients with severe sepsis from October 2014 to October 2015.According to the international guidelines for severe sepsis and septic shock set in 2012,all patients were divided into sepsis group (n =16),severe sepsis group (n =14) and septic shock group (n =20),and these patients were further divided into to survival group (n =22) and non-survival group (n =28) as per patients surviving within 28 days.Gender,age,ethnic,and Acute Physiology and Chronic Health Evaluation score (APACHE Ⅱ) were recorded.H-FABP,B-type natriuretic peptide (BNP),creatine kinase (CK),creatine kinase isoenzyme (CK-MB),and troponin-T (cTn-T) were determined within 6 hours after admission.The statistical software SPSS21.0 was used to do t test,test,and the receiver operating characteristic curve for comparison between groups.Results H-FABP in septic shock group was higher than severe sepsis group and sepsis group (P ＜ 0.01).The 28-day mortality of septic group (80％) and severe sepsis group (71.4％) were higher than sepsis group (12.5％) (P ＜ 0.01).Non-survival' s H-FABP,BNP,cTn-T,CK,CKMB was higher than survivals (P ＜ 0.05).Through the ROC of H-FABP (AUC=0.748,P=0.003,95％ C I:0.605-0.890) and BNP (AUC =0.714,P=0.010,95％ CI:0.573-0.856),it shows that H-FABP is better than BNP.when H-FABP take 9.902 ng/mL,the sensitivity of 82.1％,specificity of 63.6％.H-FABP,BNP has a certain value in 28-day mortality prediction.Conclusions Sepsis shock has significantly higher 28-day mortality than sepsis and severe sepsis.Compared with BNP,H-FABP has greater predictive value in sepsis patients,it will increase along with the aggravation of the disease;it can also predict 28-day mortality.

Objective To observe the clinical therapeutic effect of nucha electroacupuncture on patients with adult hypoxic ischemic encephalopathy(HIE)and to approach its mechanism. Methods After exclusion of cases with incomplete historical data from 80 adult HIE patients admitted in the Department of Critical Care Medicine of 401st Hospital of Jinan Military Region of PLA,finally 74 cases were randomly divided into a nucha electroacupuncture treatment group(38 cases)and a conventional therapy control group(36 cases)by random number table. The patients in the control group were treated with conventional medical therapies,including dehydration,intracranial pressure reduction,brain protection with head hypothermia,and so on. In nucha electroacupuncture group,based on the conventional treatment in the control group,additionally nucha electroacupuncture was performed for the patients. Before and after therapy,the changes of Glasgow coma scale score(GCS score)and Glasgow-Pittsburgh coma score (G-PCS score)in all the patients were assessed and compared between the two groups,and according to the standard criteria of GCS and G-PCS scores for evaluation of efficacy,the clinical therapeutic effective rates in the two groups were assessed. Results ①There were no statistically significant differences between the two groups in GCS score and G-PCS score before treatment(both P>0.05),after treatment,the GCS and G-PCS scores in nucha electrical acupuncture group were obviously higher than those before treatment(GCS score:6.22±2.66 vs. 4.33±1.35,G-PCS score:22.96±6.22 vs. 17.53±4.68,both P<0.05),and the GCS and G-PCS scores of nucha electroacupuncture group were markedly higher than those of control group after treatment(GCS score:6.22±2.66 vs. 5.17±3.01,G-PCS score:22.96±6.22 vs. 16.78±7.96,both P<0.05).②The total effective rate of nucha electroacupuncture group was significantly higher than that of control group when assessed by both the standard criteria of GCS score(73.7%vs. 50.0%,P<0.05)and G-PCS score(84.2%vs. 61.1%,P<0.05). Conclusion The nucha electroacupuncture has definite clinical therapeutic value in treatment of patients with adult HIE and it can improve their neurological function and outcome.

AIM To study the effect of Gardenia jasminoides Ellis on serum IL-1? and TNF-? level of rheumatoid arthritis rats, as well as its mechanism. METHODS An experimental type Ⅱ collagen-induced arthritic rats was established. The inhibitory effects on paw edema were observed, and serum IL-1? and TNF-? levels were determined in experimental rats. RESULTS Compared with models, Gardenia jasminoides Ellis inhibited paw edema on rats significantly, and the levels of serum IL-1? and TNF-? showed markedly decrease by Gardenia jasminoides Ellis at high dose to medium dose( P