The therapeutic response of anti-vascular endothelial growth factor (VEGF) differs among individuals.According to the changes of central retinal thickness,intraretinal fluid,subretinal fluid,best corrected visual acuity and other morphological or functional manifestations after treatment,the performance of the treated eyes can be classified as optimal response,poor response and non-response.A variety of factors could account for poor or non-response to anti-VEGF,such as genomic polymorphism and specific genomic risk alleles,lesion characteristics,vitreous and macular structural abnormalities,resistance to anti-VEGF drug,and the role of pericytes and others.The common counter measures include increasing the dosage,shortening the injection interval and replacing with another alternative drug,inhibition of pericytes,relieving vitreomacular anatomical abnormalities.It is still worthy of further exploration that how to assess individual reasons for non-response,so that we can give proper treatment to reduce the excessive use of anti-VEGF drugs and improve the clinical management of ocular neovascularization diseases.

[ ABSTRACT] AIM:To construct a prokaryotic expression plasmid to produce recombinant human tumor necrosis factor-related apoptosis-inducing ligand ( TRAIL) and to verify the biological activity of TRAIL.METHODS: The pro-karyotic expression plasmid pET-28a (+)-TRAIL114-281 was constructed.Human soluble TRAIL was obtained through opti-mized inducing protein expression and purification conditions.The biological activity of TRAIL was verified by CCK-8 as-say.The apoptosis-inducing effect of TRAIL alone and/or in combination with proteasome inhibitor bortezomib ( Velcade, PS-341) on the tumor cell lines H460 ( TRAIL-sensitive) and K562 ( TRAIL-resistance) for 24 h was determined.The ap-optotic rates of the cells were analyzed by flow cytometry with Annexin V-FITC/PI staining.The activities of caspase-8,-9 and -3 in the cells were detected by colorimetric method.The protein expression of Bax, Bcl-2 and cFLIP was measured by Western blot.The expression of DR4 and DR5 in the H460 cells and K562 cells after treated with bortezomib for 24 h was detected by flow cytometry.RESULTS:The recombinant human soluble TRAIL protein with stable bioactivity was success-fully acquired, which induced apoptosis in H460 cells and K562 cells.After treatment with different concentrations of TRAIL, the apoptotic rate of H460 cells was significantly increased with the increase in the concentration of TRAIL ( P<0.05), but the apoptotic rate of K562 cells was not affected by the increasing TRAIL concentration.Apoptotic rate in com-bination group was obviously higher than that in single group ( P<0.05 ) .In the process of apoptosis, the activities of caspase-8,-9 and -3 in H460 cells and K562 cells were both increased.The expression of Bcl-2 and cFLIP in treatment groups ( especially the combination group) was decreased compared with control group.No significant change of the Bax expression level was observed.The expression of DR4 and DR5 in the H460 cells and K562 cells was significantly up-regu-lated after treated with bortezomib ( P<0.05 ) .CONCLUSION: Bortezomib combined with recombinant human soluble TRAIL synergistically induces apoptosis in tumor cell lines H460 and K562 through initiating intrinsic apoptotic pathways by up-regulating death receptors DR4 and DR5, and reducing the expression of antiapoptotic proteins Bcl-2 and cFLIP.

Objective] To study emotional counterbalance therapy which is used in depression treatment ,it plays an important role in the treatment of emotional disorders. [Method] With the research methods of taking depression for example ,through the sad,fear of these two emotional factors to explore the pathogenesis of depression,and analyze“happiness restrains sadness“ and“thought restrains fear”in the emotional counterbalance therapy, which are used in the depression clinical application.[Result]Emotional counterbalance uses one or more of the emotions to regulate ,control,overcome the other one or more negative emotions,which based on the restriction among the five elements theory is a kind of psychological therapy.Sadandfearare the most common chief complaints in depression which belong to the emotional depression in depression disease of Chinese medicine. On the basis of “sad doing harm to the lungs”and “dread doing harm to the kidneys”,lung,kidney and depression etiology,pathogenesis,symptoms are closely related. This reflects the lung,kidney play an indispensable role in the treatment of depression. It has significant curative effects to apply the theory of emotion counterbalance,such as happiness restrains sadness,thought restrains fear to cure diseases. At the same time,with a relaxed and pleasant mood,actively guiding to help thinking is also the treatment of depression,pessimistic disappointment medicine.[Conclusion] According to the restriction among five elements theory,to use the relation and restriction between emotion and five zang-organs to regulate emotional disorders can restore to the normal balance,which is an effective psychological treatment for emotional disorders.The therapy should be used alone or combined with traditional Chinese medicine treatment in different situations to relive the treatment effect.

Objective To evaluate the efficacy of MRCP in the determination of common bile duct (CBD) exploration in gallstone pancreatitis(GP). Methods The clinical data of the patients who underwent CBD exploration due to gallstone pancreatitis during two different periods were retrospectively reviewed. Between 1995 and 1999,46 patients with gallstone pancreatitis underwent CBD explorations based on the preoperative ultrasonographic examination of stones and dilatation of CBD . Between 2000 to 2002,the explorations were carried out in 30 patients based on MRCP findings. Results Negative exploration occurred in 28 patients (60.8%) during the first period and 7 patients (23.3%) during the second period. The difference of negative CBD exploration rate between the two groups was statistical significance(P

Objective To investigate the relationships between concentrations of free fatty acid (FFA) in maternal serum and oxidative damage levels in placental mitochondria and preeclampsia ( PE)-Methods A total of 60 women with PE and 60 normal pregnant women as control participated in this study.All were admitted to Fujian Maternity and Child Health Hospital for delivery from August 2010 to May 2011.Patients with PE were divided into early-onset group ( n =30,presented at ＜ 34 weeks of gestation ) and late-onset group ( n =30,presented at ≥ 34 weeks of gestation),with 30 normal pregnant women as early control group ( ＜ 34 weeks of gestation ) and 30 as late control group ( ≥34 weeks of gestation).Improved copper agent colorimetry was used to detect FFA in maternal serum Ultraviolet colorimetry was used to detect glutathione peroxidase (GPX) and catalase (CAT) activity in maternal placenta and malondialdebyde (MDA) and permeability transiton (PT) pore in placental mitochondria.Total superoxide dismutase (SOD) assay kit-WST was used to detect SOD activity in placenta.Real-time fluorescent quantitative PCR was used to detect mitochondrial DNA (mtDNA) expression in placenta.Results ( 1 ) Maternal serum FFA was ( 1.6 ±0.5 ) mmol/L in early-onset PE group and ( 1.5 ± 0.4) mmol/L in lateonset PE group,significantly elevated as compared to ( 1.0 ± 0.5 ) mmol/L in early control group and (0.9 ±0.5) mmol/L in late control group (P ＜ 0.05 ). However,no significant difference was found between early-onset and late-onset PE groups (P ＞ 0.05 ).(2) The mean placental GPX,CAT and SOD activity were significantly decreased in the early-onset PE group [ (47 ±6),( 19 ±5),(62 ± 13) U/mg]and late-onset PE group [ (67 ±6),(20 ±4),(96 ± 17) U/mg] as compared to late control group [ (80 ±3),(55 ± 3 ),( 123 ± 19 ) U/mg],respectively ( P ＜ 0.05 ).(3) The mean placental mitochondria MDA was significantly elevated in the early-onset PE group [ (115 ± 22) nmol/mg] and late-onset PE group [(90±17) nmol/mg] as compared to late control group [(52 ± 11) nmol/mg,P ＜0.05].The mean absorption value that present the permeability of placental mitochondria PT pore was significantly elevated in the early-onset PE group (0.086 ±0.013) and late-onset PE group (0.069 ±0.014) as compared to late control group (0.052 ± 0.0 12,P ＜ 0.05 ).The mean placental mtDNA expression was significantly elevated in the early-onset PE group (3.0 ±0.7) and late-onset PE group (2.8 ±0.7) as compared to late control group ( 2.6 ± 0.6,P ＜ 0.05 ).( 4 ) The mean placental mitochondria MDA concentration correlated positively with the concentrations of FFA in maternal serum in the early-onset PE group ( r =0.703,P ＜0.05 ) and late-onset PE group (r =0.457,P ＜ 0.05 ),and negatively with placental antioxidant enzyme in the early-onset PE group ( r =- 0.652,- 0.787,- 0.952 ; P ＜ 0.05 ) and late-onset PE group ( r =-0.378,-0.689,-0.854; P＜0.05).Conclusions Increased FFA in maternal serum and high levels of oxidative damage in placental mitochondria may be involved in the pathogenesis of preeclampsia.Increased FFA in serum and decreased activity of antioxidant enzyme in placenta may contribute to oxidative damage levels in placental mitochondria in women with PE.

Objective To investigate the effect of methylprednisolone (MP) combined with puerarin in preventing the spinal cord ischemia-reperfusion injury (SCII).Methods The model of ischemia-repeffusion injury was established by clipping the abdominal aorta of rats for 30 min.Eighty male SD rats were randomly and equally divided into 4 groups: the blank group in which the abdominal aorta was only exposed,the positive drug group in which intravenous MP injection (30 mg/kg) was conducted 30 min before the establishment of the ischemia-reperfusion injury model,the therapy group in which intravenous MP (10 mg/kg)and puerarin (30 mg/kg) injection was conducted 30 min before the establishment of the model,and the model group in which the physiological saline equivalent to the volume of MP in the positive drug group were injected into the caudal vein of rats 30 min before the establishment of the model.Ten rats were taken from each group and the homogenation of the spinal cord was used to test expression level of superoxide dismutase (SOD) and sodium-potassium adenosinetriphosphatase (Na-K ATPase).For another 10 rats in each group,the BBB scoring system was used to evaluate the neural function of the hind limb immediately after recovery from anesthesia,12 h and 24 h after reperfusion,and the spinal cord was obtained 24 h after reperfusion to observe the morphous of the spinal cord neurons.Results The expression levels of SOD and Na-K ATPase in the model group,positive drug group and therapy group 3 h after reperfusion were significantly lower than that in the blank group; the expression levels of SOD and Na-K ATPase in positive drug group and therapy group were significantly higher than that in the model group,and there was no significant difference between the positive drug group and the therapy group with regard to the levels of SOD and Na-K ATPase.The BBB score was better in the positive drug group and the therapy group than those in the blank group and model group.Microscope observation showed that the degree of injury between positive drug group and therapy group was equivalent,while each of them was lower than that in the model group.Conclusion MP combined with puerarin plays a great role in the prevention of the SCII.

Objective To investigate the effect of continued nursing education manual on surgical nursing education.Methods A continued nursing education manual was designed and applied to surgical nursing education.The effects were assessed by comparing the nursing training results before and after intervention by the manual in terms of nursing theory test,nursing techniques test.Results After the application of manual,the training coverage rate increased from 94.59%to 100.00%(P<0.05),the pass rate of theory test increased from 87.57%to 94.21%(P<0.05),and the pass rate of nursing skills test increased from 90.27%to 96.14%(P<0.05). Conclusion The continued nursing education manual is effective in improving the educational effect of surgical nursing.

Purpose To evaluate the application value of rapid exchange method in transnasal intestinal obstruction catheterization. Materials and Methods Fifty-eight patients with adhesive intestinal obstruction underwent transnasal catheterization under X-ray fluoroscopy, of which 31 cases were treated with rapid exchange catheterization method (group A) and the other 27 cases with traditional catheterization method (group B), success rate, operation time and complications were compared between the two groups. Results Catheterization success rate of group A and group B were 96.77%(30/31) and 77.78%(21/27) respectively, which was significantly higher in group A than in group B (χ2=4.907, P<0.05);operation time of group A and group B were (28.2±12.3) min and (25.4±15.7) min respectively, and the difference between them was not statistically significant (t=1.219, P>0.05); no operation associated injury occurred in group A and only one case in group B (3.70%) resulted in bilateral nasal edema with a small amount of bleeding because the operating time was too long, complication rate between the two groups was also not statistically significant (P>0.05). Conclusion Rapid exchange method can improve the success rate of transnasal intestinal obstruction catheterization, but the operation time and complications are comparative to those of the conventional method.

Adult ; China ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Occupational Health ; Physical Examination

Objective] To summarize the clinical experience of Professor Yu Ying’ao in treatment of epilepsy.[Method]Starting from Professor Yu Ying’ao epilepsy treatment of two typical cases, and discuss the treatment ideas and methods.[Results] Professor Yu Ying’ao is good at treating epilepsy, many cases, he believes that phlegm and distraught as the main disease epilepsy mechanism. Emphasizes the importance in the pathogenesis of phlegm, that Qianzhen Zhi Xian in the treatment of epilepsy through usage, and treatment based on syndrome differentiation. Treatment of multiple in Puji Benshi Fang Baijin pill on the basis of adding Huotan Kaiqiao, Zhenxin Pinggan Anshen, Xifeng Zhijing. Often the effect is very good.[Conclusion] Professor Yu Yingao’s experience in the treatment of epilepsy is unique, it is worth learning.