ObjectiveTo evaluate the therapeutic effect of phacoemulsifcation and posterior chamber intraocular lens(IOL) implantation combined with trabeculectomy in patients with cataract and glaucoma.Methods26 cases(26 eyes)were theated by phacoemulsification and IOL implantation combined with trabeculectomy.Follow-up period was for 2～16 months.ResultsThe average intraocular pressure(IOP)was reducded from 24.82 mmHg preoperatively to 16.52 mmHg postoperatively.IOP was less than 21 mmHg in 88.46% eyes.Visual acuity was 0.3 or better in 80.77% of eyes during following-up.61.54% of eyes were found with functional filtering blebs.ConclusionTriple procedure is safe and suitable method for most patiants with glaucoma and cateract

Objective To investigate the efficacy of sunitinib in the treatment of patients with imatinibresistant advanced gastrointestinal stromal tumor (GIST).Methods The clinical data of 45 patients with imatinib-resistant advanced GIST who received the treatment of sunitinib (37.5 mg/d) at the First Affiliated Hospital of Sun Yat-Sen University from March 2008 to June 2012 were retrospectively analyzed.The mutation of c-kit and platelet-derived growth factor receptor α (PDGFRα) was detected,and the efficacy of imatinib was assessed after the treatment for 3 months,and factors influencing the survival were analysed.The survival rate was calculated using the Kaplan-Meier method,survival analysis was done using the one-way analysis of variance,and multivariate analysis was done using the COX regression model.Results The median time of treatment with sunitinib for the 45 patients was 11.0 months (range,4-37 months).The complete remission rate,partial response rate,rate of stabilized condition and disease progression rate were 15.6％ (7/45),8.9％ (4/45),46.7％ (21/45) and 28.9％ (13/45) after the treatment with sunitinib for 3 months.All the patients with clinical (imaging) complete remission received surgery for metastatic lesions or B-ultrasound guided ablation for single liver metastasis before the treatment with sunitinib.The most common grade 3 or 4 adverse reactions of sunitinib were hand-foot syndrome and anemia.C-kit and PDGFRα mutational analysis were carried out.C-kit exon 9 mutation was detected in 9 patients,c-kit exon 11 mutation in 21 patients,and no mutation was detected in 12 patients.The median progression-free survival time was 8.0 months (range,4.1-11.9 months),and the median overall survival time was 25.0 months (range,13.4-36.6 months).The results of univariate analysis showed that the primary lesion sites and mutational status of primary lesions were factors influencing the progression-free survival and overall survival (x2=5.967,6.622 ; 7.965,8.765,P ＜ 0.05).The results of multivariate analysis showed that only the mutational status of c-kit of primary lesions was the independent factor influencing the progression-free survival and overall survival (Wald =6.540,7.205,P ＜ 0.05).The progression-free survival and overall survival of patients with c-kit exon 9 mutation and patients with no gene mutation were significantly longer than patients with c-kit exon 11 mutation (x2 =7.965,8.765,P ＜ 0.05).Conclusion Sunitinib with a dosage of 37.5 mg/d could effectively treat patients with imatinib-resistant advanced GIST.A better survival is observed in patients with c-kit exon 9 mutation or with no gene mutation when compared with patients with c-kit exon 11 mutation.

To explore the application value of low-dose CT in lung cancer after operation in a short-term review by comparing conventional and low-dose CT. Methods:In 83 cases of lung cancer during the immediate postoperative period review, 50 cases (group A) underwent conventional CT scanning, whereas 33 cases (group B) underwent low-dose CT scanning. All CT scans were scored on the basis of image quality and clinical needs. The radiation dose indexes CTDIvol and DLP were recorded for each case. A comparison of the score and radiation dose between the two groups helped determine the existence of significant differences. Results:The average image quality scores of the two groups were 3.705±0.314 and 3.311±0.442, those for clinical demand were 2.670±0.373 and 2.561±0.410, those for CTDIvol were (19.248±1.532) mGy and (10.138±1.113) mGy, and those for DLP were (170.180±19.259) mGy*cm and (99.061±14.504) mGy*cm. The two groups exhibited significant differences in image quality, CTDIvol, and DLP but revealed no significant dissimilarity in clinical demand. Conclusion:Low-dose CT completely meets the clinical requirements for short-term follow-up after resection of lung cancer and significant reduction in radiation dose.

Objective To investigate the effects of quetiapine on serum levels of brain-derived neurotrophic factors ( BDNF) and the correlation between BDNF and psychiatric symptoms and cognitive function in patients with first-episode schizophrenia. Methods Eighty patients with first-episode schizophrenia ( treatment group) were treated with quetiapine orally for 4 weeks,at initial dose of 100 mg·d-1 and average dose of (580±120) mg·d-1 . The psychiatric symptoms were evaluated by using the positive and negative syndrome scale ( PANSS) . The cognitive function was assessed by using Wisconsin cards sort test ( WCST) . The serum BDNF level was detected with enzyme-linked immunosorbent assay ( ELISA) . Results The serum level of BDNF was markedly lower in schizophrenic patients before[(13. 72±8. 79) ng·mL-1,P<0. 01] and after treatment[(18. 02±9.06) ng·mL-1,P<0.05]in comparison with normal controls(23. 67±10. 13) ng·mL-1]. After treatment,the PANSS total scores and subscale scores decreased,WCST number of categories and the number of correct answers increased,and the number of wrong answers reduced. There was a positive correlation between the serum BDNF and negative symptoms ( SANS) ( r= 0. 54, P=0. 032),and the number of correct answers. Conclusion The quetiapine significantly increases serum level of BDNF in schizophrenia patients,which correlates positively with improvements in symptoms and cognitive function.

Objective To investigate the clinicopathological difference and prognosis of colorectal adenocarcinomas including mutinous, Signet-ring cell, papillary and tubular carcinomas. Methods Two thousand and eighty-nine patients with colorectal cancer underwent colorectal operation between August 1994 and April 2007. The clinicopathological characteristics of mucinous adenocarcinoma (n=144), signet-ring cell carcinoma (n=25), papillary and tubular carcinomas (n= 1837) were compared expect of other types of cancer (n = 83). The single factor and Logistic regression methods were used to analyze the clinicopathological parameters that influence the prognosis of colorectal cancer such as age, location of the tumor, staging, peritoneum and pathological typing. The survival rates of patients with above three types of adenocareinomas were analyzed. Results The mean age of onset was lowest in patients with mutinous adenocarcinomas [(54. 20 ± 16.25) years] compared with that in patients with signet-ring cell cancer [(40.43 ± 12.88)years] or papillary and tubular carcinomas [(58. 73 ±13.62)]. There were significant differences in gender, size and location of the tumor, TNM staging, peritoneal metastasis, lymph node involvement and adjacent organ invasion among three groups (all P values <0.05). The single factor and Logistic regression analysis revealed that both mucinous adenocarcinoma and signet-ring cell carcinoma were risk factors ot prognosis. The patients with mucinous adenocarcinoma or signet-ring cell tumor were poor in long-term overall survival in comparison with patients with papillary and tubular carcinoma (P<0. 001). Conclusions The colorectal mucinous and signet-ring cell adenocarcinomas are risk factors for prognosis of colorectal cancer, which imply the poor outcome.

ObjectiveTo investigate the expression and significance of p38 mitogen-activated protei n kinase (MAPK) in autogenous vein graft. Methods Autogenous vein graft model was established by transplanting the right jugular vein to infr arenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after s urgery,respectively. Reverse transcription-PCR and in situ hybridization,Wester n blot and immunohistochemistry methods were used to detect the expression of pr otein and phosphorylation protein of p38 and p38mRNA. ResultsThe expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%?26%),and significantly higher than that on 4,6,8 weeks( P

TEA转录因子4（TEAD4）是Hippo信号通路中转录共激活子YAP/TAZ下游最重要的转录因子TEAD家族的成员之 一。近年来，TEAD4的促癌作用被逐渐发现，其可与YAP形成转录复合体或不依赖于YAP独立调控下游相关靶基因的表达， 在 胃肠道肿瘤、肝癌、肺癌、乳腺癌等多种人类实体肿瘤中发挥促癌作用，导致肿瘤的发生和进展，并且是多种肿瘤不良预后的标 志。此外，靶向TEAD4及以阻断YAP-TEAD4结合为靶点的药物在多种肿瘤的体外实验及动物模型中取得显著的治疗效果， 提 示TEAD4可能是肿瘤治疗的一个理想靶点。本文就目前TEAD4在肿瘤发生、发展及治疗中的研究现状作一总结及展望，以期 为TEAD4的后续研究及以其为靶点的肿瘤治疗提供新思路。

OBJECTIVETo investigate the effect on intramuscular connective tissue and passive range of joint motion by the stress produced in limb lengthening.

METHODSAn animal model of limb lengthening was established in the tibia of rabbits. Distraction was initiated at a rate of 1 mm/d and 2 mm/d in two steps respectively, and both proceeded until 10% and 20% of the tibia length was achieved. Muscle samples were harvested at the time when distraction ended and at the 4th week of consolidation after the distraction. Scanning electron microscope was applied to observe the morphological changes of the perimysium. The goniometer, which we made for this study, was used to measure the passive range of joint motion.

RESULTSThe collagen fibers were partitioned in bundles, crimped and interconnected closely and orderly. In the regime of 1 mm/d distraction with 10% lengthening, no apparent changes of the collagen fiber and passive range of joint motion was demonstrated. When tibia was increased to 20%, the crimped fibers showed a tendency of being straightened while the passive range of joint motion was reduced. The findings remained the same at the 4th week of consolidation. In the regime of 2 mm/d distraction with 10% lengthening, the crimped structure of the collagen fibers in the perimysium disappeared and the fibers were almost straightened. Additionally, the interconnection of the collagen fibers became loosened and interstice was presented among the fibers. At the 4th week of consolidation, the restoration to the original crimped structure was not completed. When the lengthening ratio was increased to 20%, the collagen fibers were straightened completely. This condition remained unchanged throughout all 4 weeks. The passive range of joint motion was reduced dramatically in the regime of 2 mm/d distraction.

CONCLUSIONThe ultrastructure of perimysium and the passive range of joint motion in the regime of 1mm/d lengthening shows the condition closest to the normal ones. The regime of 2 mm/d lengthening may cause an apparent change in the ultrastructure of perimysium and passive range of joint motion.

Animals ; Bone Lengthening ; Collagen ; ultrastructure ; Connective Tissue ; injuries ; physiology ; ultrastructure ; Male ; Osteogenesis, Distraction ; Rabbits ; Range of Motion, Articular ; physiology ; Regeneration ; physiology

Objective To summarize the experiences of 5-year relative living kidney transplantation in the minorities. Methods The clinical data of HLA matching, rejection, survival and causes of death were retrospectively analyzed from 2004 to July 2009. There were 97 blood relative donations, including 1 case of father → son, 1 case of daughter → father, 1 case of mother → son, 24 cases of donation between brother and sister, 2 cases of non-blood relative donors (husband and wife),1 case of inter-ethnics, and the remaining were collateral relative donors. All the donations were voluntary, and all the recipients were minorities and all donors were their blood relatives. There were no mismatch of gene matching of 6 antigenic sites (0 MM) in 1 patient, 1 mismatch point (1 MM) in 2 patients, 2 mismatch points (2 MM) in 5 patients, 3 mismatch points (3 MM) in 10 patients, 4 mismatch points (4 MM) in 21 patients, 5 mismatch points (5 MM) in 39 patients and complete mismatch in 22 patients. Results All donors were discharged after 1 week and followed up for 3-6 months. Blood creatinine was normal and urine protein was negative. Up to July 2009, the conditions of the recipients were as follows: (1) Ninety-one receptors survived after transplantation. The longest survival time was up to 5 years. Among 9 deaths, 1 case died from myocardial infarction, 1 case from hemorrhagic shock and the others from respiratory failure (7 %) ; (2) Two renal grafts lost their functions and the patients restarted dialysis, in whom the preoperative panel reactive antibodies (PRA) of 1 patient was high and the patient had postoperative acute rejection, and the other patient stopped immunosuppressive agents on his own, leading to renal function loss; (3) After transplantation 10 patients had acute rejection, of which 2 cases received methylprednisolone plus OKT3, and the remaining 9 patients were treated with methylprednisolone. All rejections were reversed; (4) Urethral fistula occurred in one case and was improved after 45 days. Three patients had vesicoureteral anastomotic stenosis and were cured surgically. lyrnph leakage occurred in one case and was improved after 2 months. Fourteen patients had lung infection, including 7 mild lung infections which were improved after treatment, and 7 severe lung infections which died from respiratory failure.Other complications included secondary diabetes mellitus (4 cases), urinary tract infection (2 cases),acute renal failure (2 cases), deep venous thrombosis (3 cases), drug-induced liver damage (5 cases),polycythemia (5 cases), hepatitis C (3 cases), chronic allograft nephropathy (3 cases), and all were improved after treatment. Conclusion Comprehensive assessments of the donors and receptors before transplantation are guarantee to successful living kidney transplantation from relative donors; Living kidney transplantation from relative donors has the advantages of good matching, short ischemia period of donated kidney, less rejections and high survival rate of transplanted kidneys.

Objective To investigate the application of Critical Care Chest Ultrasonic Examination (CCUE)-plus (CCUE-plus) in the etiological diagnosis in patieuts with dyspnea and/or hemodynamic instability caused by abdominal abnormalities.Methods Patients who suffered from dyspnea and/or hemodynamic instability in the Department of Critical Care Medicine,Xiangya Hospital,Central South University from September 2013 to September 2016 were recruited in this study.A total of 255 consecutive patients completed CCUE within 2hrs of admission.If the diaphragm could not be seen in the routine phrenic points according to Bedside Lung Ultrasound Evaluation (BLUE) protocol,it would be found along midaxillary line and defined m-point.The 59 patients with altered diaphragmatic position (m-point was more than 2 cm higher than phrenic point) received sequential abdominal ultrasonography.The latter ultrasonographic findings were compared with CT results.Results There were 42 (71.19％) cases with positive findings of abdominal ultrasonography,including 18 cases of seroperitoneum,16 cases of intestinal obstruction and 8 cases combined.Compared with 56 patients who applied with CT exam,the abdominal ultrasonography revealed a sensitivity of 76.7％ and a specificity of 100.0％ to diagnose seroperitoneum (AUCRoc 0.917);whereas the sensitivity was 75.0％ and the specificity was 90.9％ (AUCRoc 0.778) to diagnose intestinal obstruction.Moreover,there were 44 (74.58％) patients with normal left ventricular systolic function;more than three quarters (46/59,77.97％) patients had pulmonary consolidation.Conclusion In patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities and altered diaphragmatic position in BLUE protocol,CCUE-plus protocol has a high positive predictive value of more than 90％ in abdominal abnormality.The findings of abdominal ultrasonography may change therapeutic target from cardio-pulmonary optimization to relief of intestinal obstruction or drainage of seroperitoneum.