Myasthenia gravis is an autoimmune disease caused by the failure of neuromuscular transmission,which is mediated by autoantibodies against acetylcholine receptors.Ocular myasthenia is a form of myasthenia gravis in which weakened eye muscles cause double vision or drooping eyelids.It accounts for approximately 80％ of juvenile myasthenia gravis.This review focuses on the extraocular muscle susceptibility to myasthenia gravis and the management of ocular myasthenia gravis.

Retinal neovascularization ( RNV) is a serious and causing-blindness eye disease in human beings. It occurs in severe eye diseases including diabetic retinopathy age-related tnacular degeneration etc.. In recent years vascular growth factor is the most important factors in controlling retinal endothelium proliferation and retinal neovacularization. Roundabout 4 ( Robo4 also known as Magic Roundabout) is a transmembrane receptor protein. Expression of Robo4 is restricted exclusively to sites of active angiogenesis. It has been recognized that Robo4 can control endothelial cell migration and the sprouting of new blood vessels neutralize signaling through the vascular growth factor and maintain vessel integrity. These findings could lead to new therapeutic target for RNV. The roles of Robo4 in angiogenesis and endothelial cell migration were discussed and basic research in the eye was reviewed.

The present study retrospectively analyzed 23 patients with ulnar fracture or bone nonunion who received treatment in the Department of Orthopedics, Second Affiliated Hospital of Soochow University between August 2001 and December 2008. These patients comprised 16 males, 7 females, and averaged 41.8 years old (range 20-72 years old). Of them, 14 had single ulnar fracture, 6 had monteggia fracture, 19 had fresh fracture, 1 had obsolete fracture, and 3 presented with bone nonunion and plate breakage following ulnar fracture. All patients received interlocking intramedullary nailing. Internal fixation time and the mean time to fracture healing were recorded. The function of nailed forearm was evaluated using Anderson criteria. All 23 patients were followed up in terms of intra- and post-operative complications for a period of 6 months -7.3 years. Following Hertel classification criteria, bone union occurring at a mean of 14.7 weeks was found in 23 patients. No intramedullary nail loosening, fragmentation, or incision infection was observed. Twenty patients had intramedullary nails removed but did not present recurred fracture. According to the Anderson evaluation criteria regarding forearm functions, the results were excellent in 22 patients and satisfactory in 1 patient. These findings indicated that interlocking intramedullary nailing for treatment of ulnar fracture provides less trauma, short recovery period, and low recurrence. For these advantages, it is suitable for treatment of ulnar shaft fracture, multi-segment ulnar fracture, bone defects, bone non-union, and the fractures failed after compression plating; in addition, it is a better choice in treating ulnar fracture in patients with severe soft tissue injury or osteoporosis.

C-arm based surgical navigation is a typical computer assisted surgery technique; it takes XR II images as carriers,and helps surgeons with high quality operation by demonstrate operating entity virtually. In this paper, we focused on some issues concerning C-arm based surgical navigation technique, including the system operation theory, key techniques, consisting parts,main application, advantages and shortcomings. On this basis, we also discussed the development trend of this kind of surgical navigation technique.

Pregnancy-associated plasma protein-A (PAPP-A),a high-molecular-weight zinc-binding metrix metalloproteinase,is expressed abundantly in the ruptured atherosclerostic plaque. PAPP-A can be used as a novel biological marker of plaque instability and cardiovascular events in patients with acute coronary syndrome. However,the role of PAPP-A in iscbemic stroke remains unclear. This article reviews the value of VAPP-A in predicting the risks of ischemic stroke events.

Objective To investigate the effect of goal-directed fluid treatment (GDT) on prognosis during emergency operation for craniocerebral trauma patients.Methods Thirty craniocerebral trauma patients treated with emergency craniotomy from January 2015 to October 2015 were divided into control group (n =15) and GDT group (n =15),according to the random number table.In control group,the patients [ten males and five females,age of (40.3 ± 12.1) years and weighting (62.1 ± 9.1) kg] were given conventional fluid therapy based on the intraoperative mean arterial pressure,heart rate,central venous pressure,etc.In GDT group,the patients [eleven males and four females,age of (44.5 ± 9.6) years and weighting (64.0 ± 6.9) kg] received GDT based on the stroke volume variation (SVV) under Vigileo monitor.Serum levels of neuronspecific enolase (NSE) and S100-β were respectively detected by electrochemical luminescence and ELISA method before anesthesia induction (T1),1 h after dura incision(T2),immediately after surgery (T3),6 h after operation(T4),24 h after operation(T5) and 48 h after operation (T6).Intracranial pressure and cerebral perfusion pressure (CPP) were detected at all time points,and Glasgow Coma Score (GCS) at T1,T5 and T6.Postoperative infection,brain edema,hospital stay in ICU,total hospital stay and death rate were recorded.Results Compared with control group,levels of NSE in GDT group were decreased at T4,T5 and T6 and levels of S100-β in GDT group were decreased at T3,T4,T5 and T6 (all P ＜ 0.05).Intracranial pressure in GDT group was not significantly different from that in control group (P ＞ 0.05).GCS at T6 was higher in GDT group than that in control group (P ＜ 0.05).Length of ICU stay and length of total hospital stay in GDI group were (4.5 ± 2.1) d and (14.3 ± 3.6) d respectively,shorter than (6.3 ± 1.9) d and (18.3 ± 4.0) d in control group (P ＜ 0.05).None experienced infection,brain edema and death after operation.Conclusion Compared with conventional fluid therapy,GDT is beneficial to the prognosis of craniocerebral trauma patients undergoing emergency craniotomy without increasing intracranial pressure and brain edema,and GDT can reduce hospital stay.

Objective To explore the effect of dexmedetomidine(DEX)for blood pressure,heart rate(HR) and SpO2 levels during anesthesia inquiry in elderly hypertensive(HBP)patients.Methods 96 cases with HBP accepted surgery were selected,and were randomly divided into the observation group and the control group,each group in 48 cases,The patients in the observation group continuous pumped into the 4μg/mL of DEX during surgery, while the control group continuous pumped into 0.9% sodium chloride solution during surgery.Heart rate(HR),sys-tolic blood pressure(SBP),diastolic blood pressure(DBP),pulse oxygen saturation(SpO2 )of the two groups after room entrance(T0),after DEX infusion(T1),before intubation(T2),after 2min intubation(T3)and 10 min(T4)after intubation were recorded and compared,extubated time,spontaneous breathing recovery time,call time to eye opening and hospitalization time and the incidence of adverse reactions in two groups were recorded.Results The difference of HR SBP,DBP and SpO2 at T0 and T4 between the two groups was not statistically significant(all P >0.05);HR, SBP and DBP were significantly lower in the observation group than those in the control group at T1,T2,T3(all P <0.05).There were no significant changes of SpO2 in the patientˊs after the room entrance;extubated time,spontaneous breathing recovery time,call time to eye opening and hospitalization time in the observation group were significantly lower than those in the control group(t =8.874,9.073,8.573,all P <0.05).The adverse reactions rate in the observation group was 4.2%,which in the control group was 6.3%,the difference was not statistically significant(P >0.05). Conclusion Continuous pumped DEX has a significant sedative effect in elderly HBP patients during surgery,and does not produce respiratory depression,can help elderly patients with HBP smoothly pass the perioperative period.

Objective To investigate the correlation between interleukin 18 (IL-18) gene promoter -137 G/C polymorphism and plasma levels of IL-18 and cerebral infraction.Methods A total of 218 Han patients with acute cerebral infarction in northern China were recruited and 218 sex- and age-matched health subjects were used as control group. Enzyme-linked irnmunosorbent assay was used to detcet the level of IL-18. Sequence specific primer-polymerase chain reaction was used to detect IL-18 gene promoter - 137 G/C polymorphism. Results The plasma IL-18 levels (1 47. 47 ±29. 79 ng/L vs. 78. 78 ± 16. 42 ng/L; t =29. 816, P ＜0. 01)and the frequency of - 137 GG genotype (79. 8％ vs. 67. 0％;x2 =8. 563, P =0. 032) in the acute cerebral infarction group were significantly higher than those in the control group. The risk of cerebral infarction in individuals with - 137GG genotype was 1.95 times higher than that in individuals without - 137GG genotype (odds ratio 1.95, 95％ confidence interval 1. 263-3. 012,P =0. 002); plasma IL-18 levels in patients with CG genotype were significantly higher than those in patients with CG +CC genotype (150. 00 ±27. 26 ng/L vs. 118. 47 ±21.62 ng/L, t =8. 222, P ＜0. 01). Conclusions The IL-18 gene promoter - 137 G/C polymorphism correlates with cerebral infarction in Han population in north China. The risk of cerebral infarction in individuals with GG genotype is significantly higher, and it may be associated with its influence on plasma level of IL-18.

Objective To induce experimental autoimmune myasthenia gravis (EAMG) rabbits by using T?125～147 Methods Peptides T?125～147 were synthesized referring to the residue sequence of acetylcholine receptor of Torpedo California and the rabbits were inoculated with the peptides Clinical manifestation was graded in 4 levels Electrophysiological function was assessed by repetitive nerve stimulation (RNS) and single fibre electromyography (SFEMG) tests Anti peptides antibodies were evaluated by enzyme linked immunosorbent assay (ELISA) Student t test was used to analyze the difference between the EAMG and healthy rabbits Results Following the second inoculation,the rabbits appeared weakness Clinical symptoms were improved by neostigmine At 3,5 and 10 Hz,the decrement of compound muscle action potential (CMAP) and the mean jitter (MCD) of the immunized rabbits were higher than in the healthy ones The percentage of decrement of CMAP in order of the control group and the T?125～147 group were:3 Hz: 1 625?1 317,25 375?7 945; 5 Hz: 2 000?1 732,25 625?9 102; 10 Hz: 1 750?1 392,28 875?8 709.Following the above sequence,the MCD were:3 Hz: (9 875?1 126) ?s,(25 875?7 945) ?s; 5 Hz: (11 375?0 916) ?s,(27 500?3 381) ?s; 10 Hz: (12 375?1 061) ?s,(31 000?4 811) ?s Anti peptide antibodies in immunized groups were significantly higher than those in the control group Conclusion T?125～147 might be served as the immunogenic to induce EAMG in rabbits,accompanied by elevation of anti peptide antibodies and the blockage of neuromuscular transmission

Objective To study the advances in t he relationship between the number of infiltrating dendritic cells and the posto perative prognosis of digestive malignant tumor. Methods The literature in recent years on the rela tionship between the number of infiltrating dendritic cells and the postoperativ e prognosis of digestive malignant tumor was reviewed.Results The number of infiltrating dendritic cells among esophageal cancer,and gastric carcinoma,colonic cancer and pancreatic canc er was associated with a better prognosis.Conclusion The population density of dendritic cel ls among the malignant tissue could be regarded as an independent indicator in e stimating the postoperative prognosis of malignant tumor.