Background It is very important for us to understand retinal function change in the patient with diabetic mellitus in clinic. At present,the study about diabetic mellitus associated with macular edema includes fundus fluorescense angiography ( FFA) and multifocal electroretinogram ( mfERG) etc.. However, seldom research is performed in the mfERG findings for different types of diabetic macular edema. Objective This study aimed to investigate the mfERG change in different types of diabetic macular edema compared with normal population. Methods Fifty-seven eyes with diabetic macular edema from 40 patients and 35 eyes from age-and gender-matched normal subjects were enrolled in this study. The eyes with diabetic macular edema were assigned to local macular edema group (n=16) ,diffuse macular edema group (n = 22) and cystoid macular edema ( n = 17 ) based on the manifestation of FFA. MfERG was recorded in all the individuals. The informed consent was obtained from each subject prior to any the medical examination. Results In focal diabetic macular edema group,the response density of P1 wave was significantly attenuated in ring 1 , showing a statistical difference in comparison with controls (t =2. 170,P = 0.038) ,and the latencies of P1 and N1 waves showed obvious prolong in ring 4 and 5 (t = 2.519,P = 0. 017 ;t = 2. 451 ,P = 0. 020). In diffuse diabetic macular edema group,the response densities of P1 and N1 waves were declined in ring 1,3,5 and ring 1,3,4,5 respectively,and the latencies of P, in ring 3,4 were significantly delayed respectively in comparison with controls (all P < 0. 05 ). In cystoid diabetic macular edema group, the response densities of P1 and N1 waves were lowed from ring 1 through 5 respectively, and the latencies of P1 and N1 waves were significantly longer from ring 3 through 5 and ring 4 respectively with the statistically significant difference from controls (all P<0. 05). The visual function of fovea was badly damaged. Conclusion These studies indicate that the most serious damage of visual function is in foveal area in cystoid diabetic macular edema group, and is then parafoveal area of diffuse diabetic macular edema group and perifoveal area in focal diabetic macular edema group. The outcome of mfERG presents a good consistency with FFA findings in the patients with diabetic macular edema.

Objective To reflect the capability of the Chinese reference laboratories through the assessment and analysis of the uniformity and uncertainty for GGT , LDH, ALT and AST among RELA from 2006 to 2011.Methods To collect the measurement results and the combined measurement uncertainties of all laboratories that had participated in RELA during 2006 and 2011.The testing results and uncertainties of the four enzymes among RELA were grouping analyzed.They were divided into four groups:the whole group ( all laboratories , 12-27 labs annual ) , the foreign group ( laboratories except for the Chinese laboratories , 4-10 labs annual ) , the Chinese group ( all Chinese laboratories , 6-18 labs annual ) and the reference group ( LAB 3 ).Calculate the CVs of inner-group measurement results , the bias of the Chinese group and the reference group measurement results to the foreign group and the elative standard measurement uncertainties , and evaluate the uniformity of measurement results and the ur variation trends.Results There were annual downtrend for coefficient of variation except LDH.Except ALT in 2006, CVs of the foreign group , the Chinese group and the whole group were all below 5%.The Chinese group had 87.5%(42/48) smaller CV than the foreign group in the last 6 years.The biases of the Chinese group to the foreign group were from-2%to 2%except GGT and ALT in 2006 and ALT in 2008.The Chinese group had 66.7% results less than the foreign group during 2006 and 2011.There was significant differences between the Chinese group measurement results ( 3.525 μkat/L ) and the foreign group ( 3.647 μkat/L ) of ALT high batch in 2008 (T=2.635,P<0.05).The relative standard measurement uncertainties of the four groups had the same uptrend and the low batch was 10% higher than the high batch.The reference group had a stable ur of 1.2%.The Chinese group had a lower ur than the foreign group during 2007 and 2009, but had similar levels after 2010.The Chinese group had constant relative standard uncertainties of 1.0% in 2009, 2010 and 2011.Conclusions There was no significant differences between the Chinese group and the foreign group, and they had good uniformity .The results of the relative standard measurement uncertainty were objective and stable.

Objective To compare the efficacy and safety of thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism (PE) in middle-aged and elderly patients.Methods Totally 45 patients with post-traumatic acute submassive pulmonary embolism in our hospital were selected.Patients were divided into thrombolysis group (n =22) and anticoagulation group (n=23) according to their conditions.Symptoms and signs,blood gas analysis,D-dimer,echocardiography,CT pulmonary angiography (CTPA) were performed before and after thrombolysis or anticoagulant therapy.Results There were no significant differences in clinical curative rate between thrombolysis group and anticoagulation group [95.5％ (21/22) vs.91.3％ (21/23),x2 =0.32,P＞0.05],and no case was found dead in both two groups.There was a significant difference in hemorrhage rate between thrombolysis group and anticoagulation group [27.3％ vs.4.3％,x2 =4.53,P ＜ 0.05].At 24 hours after thrombolysis or anticoagulant therapy,the improvement rate of dyspnea,PaO2 level was significantly higher and the pulmonary arterial pressure was significantly lower in thrombolysis group than in anticoagulation group [45.5％ (10/22) vs.17.4％ (4/23),(80.4±8.1) mm Hg vs.(73.6±9.3) mm Hg,(51.2±6.2) mm Hgvs.(60.3±5.7) mm Hg,respectively,all P＜0.05],and there were no statistical significances at other time points between the two groups.Conclusions The clinical curative rate and fatality rate are similar in thrombolysis group versus anticoagulation group.Hemorrhage rate is higher in thrombolysis group than in anticoagulation group.Thrombolysis can relieve dyspnea rapidly,reduce pulmonary artery pressure and make the embolized blood vessels recanalized.Patients with low bleeding risk in a critical condition are suggested to take thrombolysis therapy,while patients with high bleeding risk in a light condition are suggested to take anticoagulant therapy.

OBJECTIVETo construct self-assembly fibrocartilage model of goat temporomandibular joint disc and observe the biological characteristics of the self-assembled fibrocartilage constructs, further to provide a basis for tissue engineering of the temporomandibular joint disc and other fibrocartilage.

METHODSCells from temporomandibular joint discs of goats were harvested and cultured. 5.5 x 10(6) cells were seeded in each agarose well with diameter 5 mm x depth 10 mm, daily replace of medium, cultured for 2 weeks.

RESULTSOne day after seeding, goat temporomandibular joint disc cells in agarose wells were gathered and began to self-assemble into a disc-shaped base, then gradually turned into a round shape. When cultured for 2 weeks, hematoxylin-eosin staining was conducted and observed that cells were round and wrapped around by the matrix. Positive Safranin-O/fast green staining for glycosaminoglycans was observed throughout the entire constructs, and picro-sirius red staining was examined and distribution of numerous type I collagen was found. Immunohistochemistry staining demonstrated brown yellow particles in cytoplasm and around extracellular matrix, which showed self-assembly construct can produce type I collagen as native temporomandibular joint disc tissue.

CONCLUSIONProduction of extracellular matrix in self-assembly construct as native temporomandibular joint disc tissue indicates that the use of agarose wells to construct engineered temporomandibular joint disc will be possible and practicable.

Background Wearing of orthokeratology contact lens can slow down the development of myopia,especially in childhood.However,if wearing orthokeratology contact lens for long-term affect the corneal health is worthy of consideration.Objective This study was to evaluate the security of wearing orthokeratology contact lens in children.Methods A retrospective case-observational study was adopted.One hundred and fifty eyes of 76 myopic children aged 8-15 years were enrolled in Shanghai Tenth People's Hospital during December,2009 to December,2011.Orthokeratology contact lens were worn at night for 8-10 hours daily.Area of corneal endothelial cells,density of corneal endothelial cells,coefficient of variation of corneal endothelial cells and percentage of hexagonal cells were measured before wearing and 3,6,12,24 months after wearing.Repeated measurement of single factor analysis of variance was used to evaluate the changes of corneal endothelial cells after wearing of orthokeratology contact lens.Results No significant differences were found in the area of corneal endothelial cells and density of corneal endothelial cells among the different time points (F =11.34,P＞0.05 ; F =7.16,P＞0.05).A significant difference was seen in the coefficient of variation of corneal endothelial cells at various time points in the children(F=12.70,P=0.02),and the coefficient of variation of corneal endothelial cells was 0.36±0.02 24 months after wearing lens,which was higher than 0.28 ±0.05 before wearing lens (P＜0.05).In addition,the percentage of hexagonal cells in different time points was significantly different (F=13.40,P =0.04),and the percentages of hexagonal cells at 12 hours and 24 months after wearing lens were (62±12)％ and (60±14)％ respectively,which was significantly lower than (69±12)％ before wearing lens (P＜0.05).Conclusions Wearing of orthokeratology contact lens for over one year leads to the decrease of percentage of hexagonal cells and increase of coefficient of variation of corneal endothelial cells.

Objective To explore the relationship between the prothrombotic state and blood coagulation-fibrinolysis system changes with deep venous thrombosis(DVT)in aged patients after total joint arthroplasty,and to propose preventive measures.Methods 400 patients who underwent total hip or knee replacement from January 2003 to June 2011 were classified into suspected DVT(n=200 cases)and non-suspected DVT(n=200 cases)according to Well's clinical scoring system.The patients were divided into 4 subgroups based on the measures to prevent DVT:low molecular weigh heparin group,intermittent pneumatic bag compression group,combined above measures group,control group who refused any preventive measures.Plasma thrombin-antithrombin complex(TAT),plasmin-α2 antiplasmin complex(PAP)were determined preoperatively.Venous Doppler ultrasound was performed before surgery,4 d and 10 d after surgery to detect the presence of DVT.Results Totally 71 cases(17.8％)were diagnosed as DVT and 5 cases(1.3％)as pulmonary thromboembolism(PTE).The incidence of DVT in suspected DVT group(28.5％,57 cases)was lower than in non-suspected DVT group(7.0 ％,14 cases)(x2 =31.66,P＜ 0.01).Among patients with suspected DVT,the DVT prevalence in combined measures group(2.0 ％,1 cases)was decreased than in low molecular weigh heparin group(14.0％,7 cases),intermittent pneumatic bag compression (34.0％,17 cases)and control groups(64.0％,32 cases)(x2=4.89,17.34,18.01,all P＜0.05).In the patients with non-suspected DVT,the DVT prevalence in combined measures group(0.0％)was lower than in control group(24.0 ％,12 cases)(x2 =13.64,P＜0.01).The average preoperative level of TAT[(9.63±3.06)μg/L]in patients with DVT was higher than without DVT[(2.59±0.87)μg/L](t=35.70,P＜0.01),while PAP level in patients with DVT[(38.52± 21.13)μg/L]was reduced than without DVT[69.75±30.26)μg/L](t=8.27,P＜0.01).Conclusions The levels of TAT and PAP before total hip or knee replacement are predictive for lower extremity DVT.The clinical effectiveness of Well's scoring on DVT prevention is dependent on the different TAT and PAP state.

Objective To evaluate and summarize a new way of forward intensity modulated radia- tion therapy (IMRT) plan for nasopharyngeal carcinoma with 3Dmulti-leaf collimator (MLC) planning sys- tems is practised routinely in our department.Methods From September 2000 to July 2003 and November 2005 to March 2006,78 patients with nasopharyngeal carcinoma who were treated with eonformal radiothera- py used CT simulation for localizing,then doctors supervised the delineation of the planned tumor volume (PTV),gross tumor volume (GTV) and other sensitive organs on ACQsim workstation,and then sent the CT imagines to ELEKTA Precise Plan by DICOM RT Ethernet.Then,the physicists take over the responsibility of all directions of beam projection according to these organs and PTV shape,and completed the IMRT plan by manual correction making and the optimization of fields or segments shaped with forward 3D planning sys- tem.Results To analyse all the patient's dose distributions taking conformal radiotherapy in our hospital, we found the dose distribution and DVH data excellent,even better than the inverse planning of nasopharyn- geal carcinoma.Conclusions Intensity modulated radiation therapy (IMRT) is an advanced radiotherapy technique.A very good IMRT plan of nasopharyngeal carcinoma by forward planning can be obtained with 3D multiple leaf collimator (MLC) planning system.This planning method is more flexible,but the radia- tion physicists should be very much experienced in professional skill.

Objective To analyze the recuperation of lungs after TECAB, and probe more effective nursing care for the lungs of patients after TECAB. Methods 20 cases received the treatment of TECAB were collected during the period of January 2009 to July 2010. Due to the reason of ventilation with single lung, patients were demanded to strength breath and take right lateral position and treated with back-tapping in left lung. Meanwhile, patients were treated with back-tapping with lower intensity and more times and lower frequency vibration ( 10 - 15 time/s). The recuperation of patients were observed and analyzed. Results After treatment, the value of PaO2 and PaCO2 were in normal range, and no complications were occurred and all of them recovered from illness. Conclusions Effective and well-targeted lungs nursing is an important assurance that helps the sufferer to recover from illness and the new lungs nursing after one-lung ventilation in TECAB is effective.

Coronary heart disease is one of the most important causes of death in human, and consumes vast medical resources. Percutaneous coronary intervention (PCI) has been a significant breakthrough for its treatment. However, clinical application has been hampered by in-stent restenosis (ISR). Although drug eluting stent (DES) has reduced the occurrence of restenosis, incidence of ISR is still about 5% to 10%. The main reasons for restenosis after PCI are hyperplasia of vascular endothelial cells and smooth muscle cell migration. The exact mechanism of personalized differences in restenosis is not clear yet, but there may be a variety of risk factors. In addition to aging, smoking and diabetes, an increasing number of studies have found that genetic and epigenetic factors play an important role in ISR. In this article, authors have reviewed genetic and epigenetic factors on the progression of ISR, which may help to determine the genetic risk factors in patients with ISR after PCI.
Angioplasty, Balloon, Coronary ; methods ; Coronary Restenosis ; etiology ; genetics ; Disease Progression ; Epigenomics ; methods ; Humans ; Stents ; Treatment Outcome

Objective - To analyze the effect of using vibration tools on the prevalence of work related musculoskeletal disorders （ ） Methods ， - WMSDs in automobile factory workers. By judgment sampling method front line workers with more than one year of working experience in an automobile factory were selected as the research subjects. Musculoskeletal Disorders Questionnaire was used for investigation. The workers were divided into the control group and the vibration tool group. The propensity score ∶ ， matching method was used to balance the confounding factors of the two groups of workers by 1 1 and 568 people were Results included in each group. The prevalence of WMSDs was compared between the two groups after matching. After ， ， ， ， ， ， matching the prevalence of WMSDs in the shoulder elbow hand/wrist upper back waist hip/buttock and knee of workers in ， （ P ） the vibration tool group was higher than that in the control group and the differences were statistically significant all <0.05 .， The prevalence of WMSDs in different body parts of workers in the vibration tool group ranking from high to low was waist ， ， ， ， ， ， ， ， ， ， neck shoulder hand/wrist upper back knee ankle/foot elbow and hip/buttock with the rate of 74.3% 61.3% 54.2% ， ， ， ， ， （P ） Conclusions 54.0% 50.9% 39.4% 35.2% 31.0% and 27.1% respectively <0.01 . The use of vibration tools can ， ， ， ， ， increase the risk of WMSDs in shoulder elbow hand/wrist upper back waist hip/buttock and knee of automobile factory workers. Corresponding measures should be taken to reduce vibration intensity and reduce contact time to protect workers'