Objective To evaluate the clinical effects of surgical treatment for diabetic retinopathy(DR)with diffuse diabetic retinal edema(DDRE)and massive subretinal hard exudates(MSHE)by vitrectomy,endolaser retinal photocoagulation and long acting gas tamponade via analyzing the long term results.Methods Thirty eyes of twenty five patients with DR with DDRE and MSHE were recruited from October 2001 to December 2006.Among them,17 eyes belonged to 14 male patients and 13 eyes of 11 females.The patients' age was from 36 to 68 years(mean 54.6).The best corrected visual acuity(BCVA),color fundus photography,fundus fluorescein angiography(FFA)and optic coherence tomography(OCT)were performed preoperatively.Pars plana vitrectomy,posterior hyaloid removal,endolaser photocoagulation and long acting gas tamponade were used to treat the affected eyes.Results Preoperative BCVA was finger counting to 0.05 in all the 30 eyes.During 12-23 months of follow up period,2 eyes showed no change in BCVA,vision improvement was observed in 28 eyes(93.3%)with BCVA rising to 0.03-0.04 in 3 eyes,≥0.09 in 25 eyes,and among them the BCVA rose from 0.04 to 1.0 in one eye.The macular retina thickness thinned from preoperative ≥450?m to postoperative 160 220?m,intra-retinal and pre-retinal hemorrhage as well as MSHE was absorbed markedly or completely.Visual acuity decreased in 7 eyes(23.3%)during 24-42 months of follow up,anterior ischemic opticneuropathy occurred in 3 eyes(10%),macular edema recurred in 4 eyes(sub-macular hard exudates appeared in 2 eyes),and macular thickness measured 310-410?m.Scars in sub-fovea and peri-fovea sub-retina were noted in 5 eyes,in which the visual acuity was improved from finger counting to 0.04.Conclusion Vitrectomy,including posterior hyaloid removal,endolaser retinal photocoagulation and long acting gas tamponade may offer satisfactory effects in the treatment for DR complicated with DDME and MSHE.

Objective To investigate the immunoregulatory effects of propofol on airway hyperresponsiveness,airway inflammation and Thl/Th2 ratio in the asthmatic mice.Methods One hundred female BALB/c mice,aged 6-8 weeks,weighing 18-20 g,were randomly divided into 5 groups (n =20,each):control group (normal saline i.p.,group C),asthma group (group A),low-dose propofol (50 mg/kg i.p.,group LP),medium-dose propofol (100 mg/kg i.p.,group MP) and high-dose propofol (150 mg/kg i.p.,group HP).Mice of groups A,LP,MP and HP were sensitized with ovalbumin (OVA),mice of group C were sensitized with normal saline.24 h after the last challenge,animals were sacrificed by lethal dose of pentobarbital sodium.Blood and bronchoalveolar lavage fluid (BALF) were collected for determination of serum OVA-specific IgE and the levels of cytokines (IL-4,IL-5 and IFN-γ) in the BALF.Airway responsiveness was measured by the forced-oscillation technique and histological inflammation scores were measured by staining with hematoxylin and eosin.Results Propofol (group LP and group MP) attenuated airway hyperresposiveness to the muscarinic agonist methacholine in OVA-induced asthma.Different doses of propofol (group LP,group MP and group HP) decreased eosinoplils influx in lungs.In addition,propofol treatment reduced expression of IL-4,IL-5 and serum OVA-specific IgE and increased the ratio of IFN-γ/IL-4.Conclusion The study demonstrates a potential protective value of propofol in alleviating airway inflammation,up-regulating Th1/Th2 ratio and attenuating airway hyperresposiveness in the asthmatic mice.

OBJECTIVETo investigate a manipulating therapy for treatment of anterior shoulder dislocation in elderly.

METHODSFrom October 2011 to June 2012,27 elderly patients with anterior shoulder dislocation were treated by extorsion traction and pushing manipulation with fingers, including 7 males and 20 females aged from 65 to 86 years old with an average of 77. The course of disease ranged from 1 h to 1 d. The shoulder manifested square deformity, Dugus signs showed positive, and X-ray displayed anterior shoulder dislocation. Dugus fixation was applied for and removed external fixation at 3 weeks after operation and carried out shoulder functional exercise. Functional evaluation standard on shoulder joint injuries was used for evaluate clinical outcomes.

RESULTSAll patients were gained reduction for the first time, and followed up at 3 months after operation, no dislocation occurred. According to functional evaluation standard on shoulder joint injuries, 22 cases got an excellent result,2 cases good,and 1 case moderate.

CONCLUSIONExtorsion traction and pushing manipulating therapy for treatment of anterior shoulder dislocation in elderly, which has advantages of simple, convenient, less painful, and can avoid iatrogenic injury, is feasible to widespread.

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Manipulation, Orthopedic ; Shoulder Dislocation ; physiopathology ; therapy ; Shoulder Joint ; physiopathology ; Traction ; Treatment Outcome

Objective To explore the role of somatosensory evoked potentials elicited by paraspinal stimulation in the detection of spinal cord lesions.Methods Patients with clinically suspected spinal cord lesions underwent somatosensory evoked potentials(SEPs)and spinal cord conduction velocity(SCCV)test using paraspinal stimulating method.96 patients aged 15 to 75 years old with suspected spinal cord lesions of various aetiologies were tested.36 patients had demyelinating disease of the spinal cord,26 had sub-acute combined degeneration of the spinal cord,19 had myelopathy,10 had acute myelitis,5 had spinal cord corhpression.Results Paraspinal stimulation elicited somatosensory evoked potentials were Performed on all 96 patients,68 of whom underwent spinal MRI as well.SEPs and SCCV were found abnormal in a high ratio in all kinds of spinal cord lesions ; in general,78 among the 96 patients had abnormal SEPs with a sensitivity of 81.25%.27 out of 36 with demyelinating disease of the spine had abnormal SEPs with a sensitivity of 75.00%,23 out of 26 with subacute combined degeneration of the spinal cord had abnormal SEPs with a sensitivity of 88.46%,8 out of 10 with acute myelitis had abnormal SEPs,15 patients with myelopathy having abnormal findings,all 5 patients with spinal cord compression had abnormal SEPs.42 of 68 patients undergoing MRI revealed to be abnormal,in which 35 patients also had abnormal SEPs.The other 26 patients had normal spinal MRI,in which 21 patients had abnormal SEPs.Conclusions Paraspinal stimulation somatosensory evoked potentials and spinal cord conduction velocity may objectively document the abnormalities of electrophysiology,which occurs earlier than those of anatomy and radiological finds, therefore it may detect the dysfunction of spinal cord at an early stage.It is even more useful in the detecting of the metabolic myelopathy,which can hardly be detected by MRI.This technique is simple,inexpensive, and maybe useful in the diagnosis for patients with suspected spinal cord lesions.

Objective: To investigate the hyponatremia incidence in patients with ruptured intracranial aneurysms and the correlation with Fisher grading and cerebral vasospasm. Methods: Totally 150 patients with ruptured intracranial aneurysms from March 1998 to May 2001 were divided into anterior communicating artery (ACoA) group,posterior communicating artery (PCoA) group and middle carotid artery(MCA) group according to the sites of aneurysms.The patients were treated with GDCs interventionally and the incidences of hyponatremia were analyzed. Results: The incidences of hyponatremia in 3 groups were 48%(32/67),15%(8/52) and 16%(5/31),respectively; The incidences of severe hyponatremia of 3 groups were 30%(20/67),6%(3/52) and 6%(2/31), respectively. In ACoA group, the incidences of hyponatremia in Fisher grade Ⅲ-Ⅳ and Ⅰ-Ⅱ were 67%(20/30) and 32%(12/37) and the incidences with and without vasospasm were 71%(24/34) and 24%(8/33), respectively. Conclusion: The ACoA group has a significantly higher incidence of common and severe hyponatremia than the other groups. In ACoA group,hyponatremia is significantly more often in Fisher grade Ⅲ-Ⅳ cases and those with vasospasm.

Objective To explore clinicopathological features and prognosis of juvenile granulosa cell tumor (JGCT).Methods Patients were divided into JGCT group (n=10) and the adult granulosa cell tumor (AGCT) group (n=10).The tumor samples were examined by HE and immunohistochemical methods.Results Age of JGCT group ranged from 7-31 years (average 20.5 years);90% occurred before 30 years old.Diameter of the tumors ranged from 5.5 cm to 15.0 cm,average 9.8 cm.Characteristic features included nodular arrangement,irregular formation of follicles containing muein and luteinization, atypical hyperplasia of ceils and high mitotic activity.Nuclei grooved and Call-Exner bodies were absent or rare.Survival rate was 90% in 5 years.Age of AGCT group ranged from 14-74 years (average 45.1 years);AGCT occurred mostly in over 40 years old.Atypical hyperplasia of cell,mitotic activity and luteinization were absent or rare.Nuclei grooved and eall-Exner bodies were common.Survival rate was 100% in 5 years.Immunohistochemical staining were positive for p53 at 70%,PCNA at 90% in 10 cases of JGCT and p53 at 10%,PCNA at 20% in 10 cases of AGCT(P

0.05). However, during episode the inspiratory frequencies in patients with chronic asthmatic bronchitis〔PF=(176.68 ?36.84)Hz,Q 25% =(171.32?32.64)Hz,Q 50% =(229.69? 31.87 )Hz,Q 75% =(382.36? 55.21 )Hz, respectively〕 was significantly lower than that in asthmatics 〔PF=(354.21?67.58)Hz,Q 25% =( 286.42 ? 53.68 )Hz,Q 50% =(386.77?74.18)Hz,Q 75% =(554.68?84.72)Hz,respectively, P

Objective To detect the sperm apoptosis rate and level of reactive oxygen species (ROS) in seminal plasma and explore their correlation among infertile males. Methods Ninety-two inferitile males were divided into varicocele (VC) group (n=32), leukocytospermia group(n=30) and the other cause group (n=30), and another 24 in vitro fertilization sperm samples were sereved as controls. The routine sperm parameters including seminal pH, sperm viability and sperm density were examined by computer assisted sperm analysis, the sperm apoptosis rate was asseseed using Annexin V/PI staining, and the ROS level in seminal plasma was detected by TBA method. The differences in seminal parameters between three infertile groups and control group were compared, and the correlation of sperm apoptosis rate with level of ROS in seminal plasma was explored in each group. Results The sperm viability of three infertile groups was significantly lower than that of control group (P<0.01). The sperm apoptosis rates and levels of ROS in seminal plasma in VC group and leukocytospermia group were significantly higher than those in control group (P < 0.05 or P < 0.01). The sperm apoptosis rate was positively correlated with the level of ROS in seminal plasma in leukocytospermia group(r=0. 573, P < 0.05). Conclusion The increased sperm apoptosis rate and level of seminal plasma ROS may be related to the infertility of patients with VC and leukocytospermia. The increased level of seminal plasma ROS may be one of the causes of increased sperm apoptosis rate in patients with leukocytospermia.

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment.

Objective:To investigate the expression of wild type estrogen receptor(wER)and the ex-on-5 deleted ER(variant ER,vER)in human hepatocellular carcinoma(HCC)samples,and thereafteranalyze the possibility of HCC treatment by endocrine therapy.Methods:The mRNA expressions of wERand vER were analysed from 28 cases of HCC by RT-PCR.The expression of ER at the protein level wasdetected by immunohistochemistry(IHC).Results:IHC results showed that 39.3% of the HCC speci-mens expressed ER.The mRNA of wER was detected in 89.3%(25/28)of the HCC specimens whilethat of vER was detected in 96.4%(27/28).Twenty four out of 28 HCC cases(85.7%)expressedboth wER and vER.One out of 28 patients(3.5%)expressed only wER whereas 3 patients out of 28(10.7%)expressed vER only.Conclusion:Ninety six percent(27/28)of the HCC patients expressedvER,which suggests that the expression of vER is an important event in the development of HCC.