Background 23G pars plana vitrectomy has been widely applied to treat diabetic retinopathy (OR).Researching the influence of 23G pars plana vitrectomy on corneal endothelium cell has a great clinical significance.Objective To observe the influence of 23G pars plana vitrectomy on corneal endothelial cells in phakic eyes of diabetes and non-diabetes patients.Methods A retrospective study was designed.One hundred and twenty-four eyes of 124 patients with vitreoretinopathy were included in Affiliated Hospital of Qingdao University from August 2012 to June 2013.The patients were assigned to DR group (52 eyes) and non-DR group (72 eyes).23G pars plana vitrectomy was performed on all the patients under their informed consent.Endothelial cell density,corneal thickness(CT),coefficient of variation (CV) of cellular area,standard deviation (SD) of average cellular area and percentage of hexagonal endothelial cells were measured before and 1 day,3 days,1 week,2 week,1 month and 3 months after surgery with Topcon SP-3000P corneal specular microscope.Results No significant differences were found in the central corneal endothelial cell density between the DR group and non-DR group at various time points (Fgroup =2.148,P=0.150;Ftime =0.900,P=0.504).The CV of endothelial cells,SD of endothelial cellular area and CT in the first day after surgery were higher than preoperation (P =0.000,0.011,0.033),while the percentage of hexagonal endothelial cells was declined (P =0.001).The CV of endothelial cells and the percentage of hexagonal endothelial cells recovered in postoperative 1 month in the DR group.In the non-DR group,the CV of endothelial cells and CT elevated in postoperative 1 day in comparison with preoperation (P =0.002,0.003),and the percentage of hexagonal endothelial cells reduced (P =0.000).These abnormalities returned to a preoperative level in a week after surgery.Conclusions 23G pars plana vitrectomy results in a reversible morphology damage of corneal endothelial cells.These damage may be more severe with a longer duration in DR patients compared with non-DR patients.

Objective To observe the changes of retinal morphology and function of macular-off rhegmatogenous retinal detachment (RRD) after scleral bulking.Methods In this prospective study,42 eyes of 41 patients who underwent scleral bulking were enrolled.There were 26 males (27 eyes) and 15 females (15 eyes),with an average age of (33.78± 11.21) years.Best corrected visual acuity (BCVA),intraocular pressure,indirect ophthalmoscope,visual fields,optical coherence tomography (OCT) and B scan of ocular ultrasound were measured for all patients.The average BCVA was 0.29±0.18.The retinal detachment time was (21.12±3.71) days.The mean visual field defect (MD) was (13.54±6.44) dB.The mean loss variance (LV) was (8.43±2.11) dB.All the patients were performed cryotherapy and sub-choroidal fluid drain out.The mean follow up was 12.4 months (from 6 to 24 months).At two weeks,1,3,6,12 months after surgery,the changes of BCVA,visual fields,retinal morphology and subretinal fluid were observed.Results Indirect ophthalmoscope combined with B scan showed the time of retinal reattachment was (7.32±2.53) days.Subretinal fluid was found completely absorbed by OCT with a mean of (7.82±3.52) months.At 12 months after surgery,subretinal fluid was completely absorbed in 37 eyes (88.10％).In these 37 eyes,15 eyes had normal retinal microstructure,5 eyes had neuroepithelial cystoid edema; 12 eyes had disrupted inner segment/outer segment (IS/OS) junction,and 5 eyes had disrupted IS/ OS and external limiting membrane (ELM).BCVA at 6 months after surgery was no significant difference with that at 12 months after surgery (t=-0.636,P=0.529).At 12 months after surgery,there were4 retinal patterns on OCT examination,including normal retinal microstructure,neuroepithelial cystoid edema,IS/OS line disruption,and IS/OS and ELM disruption.The BCVA difference among these 4 groups was significant (F =52.42,P ＜ 0.05).The BCVA difference between eyes with or without residual subretinal fluid was significant (t=-5.747,P=0.000).At 1,2 weeks and 1,3,6,12 months after surgery,the MDwere (11.38±2.53),(10.14±2.19),(9.17±2.13),(6.63±1.70),(5.71±1.89),(5.14± 1.69) dB respectively,with a significant difference between these time-points (F=63.528,P =0.00).However,the MD at 6 months after surgery was no significant difference with that at 12 months after surgery (t=1.442,P=0.157).At 12 months after surgery,there were 12 eyes with normal MD,30eyes with higher MD.There was no significant difference between surgery eyes with higher MD and fellow eyes in MD (t =-1.936,P =0.06).The MD value was positively correlated to the time of retinal detachment in patients with normal retinal microstructure (r=0.84,P =0.00).There were differences in LV during different periods after surgery (F=57.25,P =0.00).Conclusions The retinal microstructure,visual acuity,visual fields were gradually improved after scleral bulking.The patients had better vision with normal retinal microstructure.The time of retinal detachment positively correlated with visual fields damage.

Objective To evaluate the clinical effects of large dosage capoten(captopril)combined with irbesartan in the treatment of congestive heart failure(CHF).Methods One hundreds thirty nine patients of CHF were occasionally divided into two groups:large dosage capoten group(n=61)and large dosage capoten+irbesartan group (n=78).240 days later,the changes of cardiothoracic ratio(CTR),left ventricular end diastolic diameter(LEVD),left ventricular end contract surface(LVES),left ventricular eiection fraction(LVEF),6-minute walking test (6MWT),admission frequency,and mortality rate were observed before and after therapy.Results Large dosage capoten+irbesartan group can significantly reduce the admission frequency of CHF patients(P＜0.01),while large dosage capoten group was better than large dosage capoten+irbesartan group in 6MWT,LEVD,LVES,and LVEF (P＜0.05).There was no significant difference in CTR and mortality rate between two groups(P＞0.05)Conclusion Capoten combined with irbesartan have better clinical effects than single capoten in the treatment of CHF and it was worthy of extending in clinic.

Objective To observe the impatcts of health care follow-up after chronic heart failture on cardiovascular events and qualigy of life.Methods One hundred and sixty-six patients who were confirmed to have chronic heart failture in our hospital during February 2007 and December 2008 were enrolled in this investigation.The patients were then assigned to the health management group (n=65) or the non-health management group (n=101) and followed up for 5 years.All-cause mortality,readmission for heart failture and quality of life (SF-36 score) were evaluated.Results There was no significant difference of all-cause mortalitv between the two groups (health management group:12.30％ (8/65); non-health management group:14.85％ (15/101; x2=0.22,P＞0.05),although a statistically significant difference of readmission rate was found between the two groups (health management group:12.30％ (9/65); non-health management group:35.64％ (36/101; x2=9.51,P＜0.05).In health management group,the scores of SF-36 were significantly increased at 3 (114.11 ±2.76) or 5 years (116.07± 15.43) when compared with baseline (91.37 ± 2.62) (x2 =102.39,P＜0.05).For the non-health management group,the scores of SF-36 were significantly decreased from 92.65±3.65 at baseline to 90.09±5.12 at 3 years or 89.08±5.71 at 5 years (x2=102.39,P＜0.05).Conclusion Health care follow-up after chronic heart failture may not decrease all-cause mortality,although can decrease readmission rate and improve quality of life of the patients.

AIM: This study aimed at investigating the effects and mechanism of total alkaloids from Rhizoma Coptidis (TA) on ethanol-induced gastric mucosal injury in rats. METHODS: The experimental gastric damages were established by intragastric ethanol, and the protective effects of TA were evaluated by calculating lesion indices contents and superoxide dismutase (SOD) activity from rat gastric mucosa were measured to explore the interrelation between therapeutic effects of TA and these factors. The expressions of neuronal nitrogen monoxide synthase (nNOS), endothelial NOS (eNOS), and inducible NOS (iNOS)from ethanol-damaged gastric mucosa in rats were analysised using immunohistochemical method. RESULTS: TA significantly inhibited the gastric injury induced by ethanol ,in dose-dependent manner,and the effect of TA was superior to that of Berberine (Ber). TA obviously antric mucosa. TA significantly suppressed ethanol-induced decreasing nNOS and eNOS expression and elevation of iNOS expression in rat gastric mucosa. CONCLUSION: Rhizoma Coptidis is a potent candidate in therapeutic drugs of human alcohol-induced gastric injury. Its anti-injury effects involve in Ber and other ingredients of TA. The protective mechanisms of TA involve in inhibiting generation of oxygen-derived free radical, accelerating scavenging of free radicals, relieving lipid peroxidation, and maintaining NO content in normal level by inhibiting decreasing of nNOS and eNOS expression and elevation of iNOS expression.

Objective o observe the expression of Notch1 and Delta-like ligand 4 (Dll4) on the fibrovascular membranes in proliferative diabetic retinopathy (PDR),and investigate its relationship with vascular endothelial growth factor receptor 2 (VEGFR2).Methods Fifty-seven PDR patients (60 eyes) who underwent vitrectomy were enrolled in this study.The PDR patients were divided into non-injection group (30 patients,32 eyes) and injection group (27 patients,28 eyes).The eyes in injection group received intravitreal injection with ranibizumab at 2 to 7 days before surgery.The preretinal fibrovascular membranes were obtained from the PDR patients during vitrectomy.Eighteen epiretinal membranes were obtained from the non-diabetic patients was served as controls.The real-time polymerase chain reaction (RT-PCR) and immunohistochemical methods were used to detecting the expression ofNotch1,Dll4 and VEGFR2.In the meantime,the numbers of the nucleus of vascular endothelial cells in the membranes stained with hematoxylin were counted.Results The immunohistochemical staining revealed that there were positive expression ofNotch1,Dll4 and VEGFR2 in all PDR membranes,regardless of the injection of the ranibizumab.The levels ofNotch1,Dll4 and VEGFR2 protein in non-injection group were higher than those of injection group (t=3.45,6.01,4.08;P=0.030,0.008,0.023).In injection group,the number of endothelial cells in the membranes reduced (17.17 ± 2.48) compared with that of the non-injection group (41.50± 5.57).There was significant difference in the number of endothelial cells in the membranes between the two groups (t=9.58,P＜0.05).RT-PCR showed that the differences of the mRNA expression ofNotch1,Dll4 and VEGFR2 were all statistically significant among the PDR group and control group (H=12.50,12.50,12.02;P＜0.05).The expression ofNotch1,Dll4 and VEGFR2 in the PDR membranes was higher than that of epiretinal membranes from non-diabetic patients.In the PDR group,the expression of Notch1,Dll4 and VEGFR2 of non-injection group was higher than that of injection group.Spearman correlation analysis showed that the expression of mRNA between VEGFR2 and Dll4 (r=0.83),VEGFR2 and Notch1 (r=0.81),Notch1 and Dll4 (r=0.87) were all significantly correlated (P＜0.05).Conclusions The expression of Notch1 and Dll4 in the PDR membranes are higher than that of the control group,and it is positively correlated with the expression of the VEGFR2.Notchl and Dll4 play a regulatory rule in the neovascularization in PDR,the acting way may be correlated with VEGFR2.

Objective To observe the effect of different concentration netrin-1 on retinal vascular permeability in diabetes mellitus (DM) rats.Methods Eighty adult Sprague-Dawley rats were randomly divided into 8 groups,10 rats in each group,including normal control group (group A),normal+balanced salt solution (BSS) group (group B),normal+netrin-1 (500 μg/ml) group (group C) and DM group (50 rats in 5 subgroups).DM rats were induced by intraperitoneal injection of streptozocin.Three months after intraperitoneal injection,10 DM rats in the control group were injected with BSS (group D).Forty DM rats were injected with 5 μl of different concentrate netrin-1,and were divided into DM+netrin-1 10 μg/ml group (group E),DM+netrin-1 50 μg/ml group (group F),DM+netrin-1 100 μg/ml group (group G),DM+netrin-1 500 μg/ml group (group H)according to the different concentration.Non-DM rats in group C were injected with netrin-1 500 μg/ml.The expression of occludin was determined by immunohistochemistry for protein,and by real-time fluorescence quantitative reverse transcription polymerase chain reaction for mRNA level.Retinal vascular permeability was measured by Evans blue infusion.Results The expression of occludin protein and mRNA in group D were less than group A (t=27.71,8.59;P=0.00,0.00).However,the retinal vascular permeability increased in group D (t=-42.72,P=0.00).The expression of occluding protein,occludin mRNA and retinal vascular permeability showed significant differences between group D,E,F,G and H (F=146.31,16.54,67.77;P=0.00,0.00,0.00).Compared the group B with group C,there was no significant differences between the expression of occludin protein,occludin mRNA and the retinal vascular permeability (t=-1.13,0.93,1.04;P=0.27,0.36,0.31).The concentrate of netrin-1 showed a significant positive correlation to the expression level of occludin and occludin mRNA (r=0.73,0.81;P=0.00,0.00),but negative correlation to the vascular permeability (r=-0.61,P=0.00).Conclusion Netrin-1 can reduce the DM rats' retinal vascular permeability,which depended on the concentration of netrin-1.

Objective: To analyze influence of acute coronary syndrome (ACS) complicated abnormal glucose metabolism on fibrinolytic system. Methods: A total of 135 ACS inpatients were selected. According to glucose metabolism status, they were divided into pure ACS group (n=48), type 2 diabetes mellitus (T2DM) + ACS group (n=46) and impaired glucose tolerance (IGT) + ACS group (n=41); another 35 subjects hospitalized and undergoing physical examination during the same period were enrolled as normal control group. Plamsa DD levels were measured and compared among all groups. Results: Compared with normal control group and pure ACS group, there were significant rise in triglyceride level [(1.12±0.39) mmol/L, (1.52±0.92) mmol/L vs. (2.57±1.17) mmol/L, (2.32±0.96) mmol/L] in T2DM+ACS group and IGT+ACS group, P<0.01 all; compared with normal control group, there were significant rise in plasma DD level in pure ACS group, T2DM+ACS group and IGT+ACS group [(360.50±74.95) ng/ml vs. (795.24±134.10) ng/ml vs. (663.31±116.06) ng/ml, (702.40±126.64) ng/ml] P<0.01 all, and those of T2DM+ACS group and IGT+ACS group were significantly lower than that of pure ACS group, P<0.05 both. Conclusion: Fibrinolytic system function of patients with ACS complicated impaired glucose tolerance is significantly lower than that of pure ACS patients.

Objective To observe and contrast the effects of dexmedetomidine and ketamine on the restlessness and analgesia during recovery period of anesthesia after tonsillectomy in children. Methods Sixty ASA Ⅰ-Ⅱ child patients underwent tonsillectomy and adenoidectomy were randomly divided into three groups, group P (appropriate amount of placebo was given in the operation), group D (dexmedetomidine) and group K (ketamine). Data of mean arterial pressure and heart rate of three groups were documented before anesthesia (T0), during extubation (T1), 5 min (T2), 10 min (T3), 15 min (T4) and 30 min (T5) after extubation were recorded. The analepsia time, adverse reactions, restlessness score and pain score were collected in three groups of patients. Results Compared with group P, values of mean arterial pressure and heart rate were more stable at T1, T2 and T3 in groups D and K (P<0.05). The restlessness score, incidence of restlessness and adverse reactions were lower in groups D and K than those in group P (P<0.05), and which were lower in group D than those of group K (P<0.05). Conclusion Both dexmedetomidine and ketamine can play an analgesic role in recovery period of anesthesia and reduce restlessness, adverse reactions and pain score in child patients. Moreover, dexmedetomidine is more effective on inhibiting restlessness and adverse reactions.

Objective: To comparatively study the atrial ifbrillation (AF) in patients with Han, Uygur, Kazak and Hui ethnic groups in Urumqi city.
Methods: A total of 1510 AF patients treated in 12 hospitals in Urumqi city from 2008-01 to 2012-12 were retrospectively studied. There were 1310 patients enrolled in our research including the 4 ethnic groups of Han, n=995 (75.95%), Uygur, n=168 (12.82%), Kazak, n=55 (4.20%) and Hui, n=92 (7.02%).
Results: ①The gender ratios were similar in 4 ethnic groups, P>0.05, while the AF type, cardiac function and risk factors were different, all P<0.05.②The blood pressure was similar in 4 ethnic groups, P>0.05, while the blood routine test, biochemistry and cardiac ultrasound examination were different, all P<0.05.③The treatments were different among 4 ethnic groups, all P<0.05.
Conclusion: The AF patients were different in AF type, biochemistry, cardiac ultrasound and function, anti-coagulation treatment among 4 ethnic groups of Han, Uygur, Kazak and Hui in Urumqi city.