Dysregulation and activation of immune processes are important in age-related macular degeneration (AMD) pathogenesis.The single nucleotide polymorphism of complement factor H is widely recognized as a risk factor to AMD.Over-activation of nod-like receptor3 and polymorphism of Toll-Like Receptor 3 also associated with AMD.Except for innate immune processes,adaptive immunity also play a critical role in AMD,a growing body of evidence supports that auto-antibodies and T cells are related with AMD.Additionally A2E and lipid oxidation byproducts might also have a role in AMD pathogenesis.

Objective To explore the safety and feasibility of vagus nerve-preserving Da Vinci robotassisted radical gastrectomy for gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 12 gastric cancer patients who underwent vagus nerve-preserving Da Vinci robotassisted radical gastrectomy at the Southwest Hospital of the Third Military Medical University from January 2015 to November 2016 were collected.All patients underwent vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer.During operation,lymph node dissection of the pyloric region,the right side of the cardia and the superior margin of the pancreas were noticed,and other surgical procedures were the same as the traditional Da Vinci robot-assisted radical gastrectomy.Observation indicators:(1) intra-and post-operative situations:surgical methods,digestive tract reconstruction,operation time,volume of intraoperative blood loss,number of lymph node dissected,results of postoperative pathological examination,recovery time of gastrointestinal function,time for liquid diet intake,duration of postoperative hospital stay,short-term surgery-related complications (postoperative bleeding,anastomotic fistula,obstruction and intra-abdominal infection);(2)follow-up situations:postoperative long-term complications (gastric retention,alkaline reflux gastritis,dumping syndrome,gallbladder disease and cholelithiasis),postoperative quality of life (diet,upper abdominal discomfort,nausea,vomiting and diarrhea),postoperative nutritional status [body weight,hemoglobin (Hb),total protein (TP),albumin (Alb)] and tumor recurrence.Follow-up using telephone interview and outpatient examination was performed up to December 2016.Telephone interview included detecting diet of patients,digestive tract symptoms and body weight.Routine blood test,liver and kidney functions,tumor markers,chest X-ray,abdominal computed tomography (CT) or color Doppler ultrasound and gastroscopy of outpatient examinations were performed to detect tumor recurrence and metastasis.Measurement data with normal distribution were represented as x±s and measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative situations:all the 12 patients underwent successful vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy for gastric cancer,without conversion to laparoscopic surgery or open surgery,including 2 patients with D1 lymphadenectomy,2 patients with extended D1 lymphadenectomy and 8 patients with D2 lymphadenectomy.Five and 7 patients underwent respectively Billroth Ⅰ anastomosis and Billroth Ⅱ anastomosis of digestive tract reconstruction.Operation time,volume of intraoperative blood loss and number of lymph node dissected of 12 patients were (247± 34) minutes,(94 ± 23) mL and 27 ± 7,respectively.Results of postoperative pathological examination showed that distal and proximal surgical margins of 12 patients were negative and achieved R0 resection;326 lymph nodes were dissected,6 patients didn't have lymph node metastasis and 18 positive lymph nodes were detected in 6 patients.Recovery time of gastrointestinal function,time for liquid diet intake and duration of postoperative hospital stay in 12 patients were (57±14)hours,(64± 14)hours and (7.3±0.9)days,respectively.There was no occurrence of short-term surgery-related complications.(2) Follow-up situations:12 patients were followed up by telephone interview (10 receiving outpatient exaninations) for 9 months (range,1-20 months).Of 12 patients with long-term complications,2 had loss of appetite,1 had diarrhea,without occurrence of cholelithiasis,cholecystitis,gastric retention and dumping syndrome.Of 10 patients receiving outpatient examinations,body weight,Hb,TP and Alb were (56± 12) kg,(126± 10) g/L,(69.9±5.1) g/L,(43.2±3.3)g/L at 1 month postoperatively and (52±13)kg,(126±10)g/L,(72.1±2.4)g/L,(45.2±1.6)g/L at 3 months postoperatively,respectively,with negative carcinoembryonic antigen.There was no tumor recurrence and metastasis in 12 patients.Conclusion Vagus nerve-preserving Da Vinci robot-assisted radical gastrectomy is safe and feasible for gastric cancer,which has not affected the lymph node dissection and incidence of surgeryrelated complications,and it also can improve the postoperative quality of life and maintain good nutritional status.

Objective To study the psychological changes and the effect of psychological intervention and to discuss the influence of psychological rehabilitation on carcinoma patients after comprehensive interventional therapy.Methods 100 carcinoma patients were divided into two groups randomly:the psychological intervention group(50 casea) received both psychological intervention therapy and comprehensive intervention therapy;the control group (50 cases) received only comprehensive interventional therapy;Curative effects were assessed with the Symptom Checklist90(SCL-90) ,the Self Rating Depression Scale(SDS) and the Self Rating Anxiety Scale(SAS) for each patient. Results For the psychological intervention group, SCL-90 scores after therapy was significantly lower than that before therapy ( P < 0. 05 ), and were also significantly lower than that ( without anxiety agent) of the control group. The scores of SDS and SAS in post-therapy patients were significantly lower than that of pre-therapy patients in the psychological intervention group. The scores of SDS had no statistical difference between post-therapy patients and pre-therapy patients in the control group. The scores of SAS in post-therapy patients was significantly lower than that of pre-therapy patients in the control group. Both scores of SDS and SAS in the control group were significantly higher than that of the psychological intervention group after therapy. Conclusion Psychological intervention for carcinoma patients after comprehensive interventional therapy played an promotional role in psychological rehabilitation in the community.

Objective To investigate the effects of exosomes from cultured human retinal pigment epithelium (ARPE-19) cells affected by oxidative stress on the proliferation and expression of vascular endothelial growth factor-A (VEGF-A) and Akt of ARPE-19 cells. Methods Culture ARPE-19 cells. The concentration of 2.5μmol/L rotenone was selected to simulate oxidative stress and isolated ARPE-19-exosome. Exosomes were isolated by ExoQuick exosome precipitation solution. Transmission electron microscopy was used to identify the morphology of exosomes. Western blot was used to detect exosomes’ surface-specific maker protein CD63. ARPE-19 cells affected by oxidative stress were cultured with exosome as experimental group, normal ARPE-19 cells were cultured with exosome as control group. The cell proliferation was examined by methyl thiazolyl tetrazolium assay. Western blot and immunofluorescence assay were used to detect the expression levels of VEGF-A and Akt protein. Real-time quantitative polymerase chain reaction (RT-PCR) was used to detect the levels of VEGF-A mRNA and Akt mRNA. Results The diameter of normal ARPE-19-exosomes ranged from 50 to 150 nm. The isolated exosomes expressed CD63. AREP-19 cells were cultured with ARPE-19 (affected by rotenone)-exosome, the cell viability in experimental group was significantly reduced than in the control group. Green fluorescence was observed in the cytoplasm under fluorescence microscope. Compared with the control group, VEGF-A was up-regulated expressed and Akt was down-regulated expressed. Western blot results showed that, VEGF-A protein expression in the experimental group were higher than the control group. Akt protein expression in the experimental group were less than the control group. The difference was statically significant (t=3.822, 6.527;P<0.05). RT-PCR results showed that VEGF-A mRNA expression levels was higher in the experimental group than the control group. Akt mRNA expression levels was lower in the experimental group than the control group. The difference was statically significant (t=8.805,?7.823;P<0.05). Conclusions Exosomes from ARPE-19 cells affected by oxidative stress inhibit the proliferation of normal ARPE-19 cells, increase the expression of VEGF-A and reduce the expression of Akt.

Objective To investigate the effect of arginase (Arg) inhibitor N-ω-Hydroxy-L norArginine (nor-NOHA) on high glucose cultured rhesus macaque retinal vascular endothelial cell line (RF/6A) in vitro.Methods The RF/6A cells were divided into the following 4 groups:normal control group (5.0 mmol/L of glucose,group A),high glucose group (25.0 mmol/L,group B),high glucose with 125 mg/L nor-NOHA group (group C),and high glucose with 1％ DMSO group (group D).The proliferation,migration ability and angiogenic ability of RF/6A cells were measured by Methyl thiazolyl tetrazolium (MTT),transwell chamber and tube assay respectively.The express of Arg Ⅰ,eNOS,iNOS mRNA of RF/6A cells were measured by real-time polymerase chain reaction (RT-PCR),Enzyme-linked immuno sorbent assay (ELISA) was used to detect the expression of NO and interleukine (IL)-1b of RF/6A cells.Results The proliferation,migration,and tube formation ability of group A (t=2.367,5.633,7.045;P＜0.05) and group C (t=5.260,6.952,8.875;P＜0.05)were significantly higher than group B.RT-PCR results showed the Arg Ⅰ and iNOS expression in group B was higher than that in group A (t=6.836,3.342;P＜0.05) and group C (t=4.904,7.192;P＜0.05).The eNOS expression in group B was lower than that in group A and group C (t=4.165,6.594;P＜0.05).ELISA results showed NO expression in group B was lower than that in group A and group C (t=4.925,5.368;P＜0.05).IL-1b expression in group B was higher than that in group A and group C (t=5.032,7.792;P＜0.05).Conclusions Nor-NOHA has a protective effect on cultured RF/6A cells in vitro and can enhance its proliferation,migration and tube formation.The mechanism may be inhibiting the oxidative stress by balancing the expression of Arg/NOS.

Objective To discuss the therapeutic strategy and the clinical efficacy of percutaneous cholecystostomy in treating high-risk patients with acute cholecystitis. Methods During the period of Jan. 2006-June 2008,percutaneous cholecystostomy was performed in 27 high-risk patients with acute cholecystitis,consisting of lithic cholecystitis (n = 21) and non-lithic cholecystitis (n = 6). Of 27 patients,percutaneous cholecystostomy via transhepatic approach was performed in 22 and via transperitoneal approach in 5. The 7 F drainage catheter was used. Cholecystography was conducted before the drainage catheter was extracted. Results Percutaneous cholecystostomy was successfully accomplished in all 27 cases,with a technical success rate of 100%. Postoperative patency of gallbladder drainage was obtained in 25 patients,with the relieving or subsiding of abdominal pain and the restoring of temperature and leukocyte account to normal range within 72 hours. In one patient,as the abdominal pain relief was not obvious 72 hours after the procedure,cholecystography was employed and it revealed the obstruction of the drainage catheter. After reopening of the drainage catheter,the abdominal pain was relieved. In another case,cholecystography was carried out because the abdominal pain became worse after the procedure,and minor bile leak was demonstrated. After powerful anti-infective and symptomatic medication,the abdominal pain was alleviated. The drainage catheter was extracted in 25 patients 6-7 weeks after the treatment. Of these 25 patients,12 accepted selective cholecystectomy,7 received percutaneous cholecystolithotomy and 6 with non-lithic cholecystitis did not get any additional surgery. The remaining two patients were living with long-term retention of the indwelling drainage-catheter. Conclusion Percutaneous cholecystostomy is a simple,safe and effective treatment for acute cholecystitis in high-risk patients. This technique is of great value in clinical practice.

Objective To establish a set of scientific and quantifiable performance management standard system by using Balance score card rationale so as to supply effective results management base for nursing regulator. Methods Delphi method was used to screen each level of nursing evaluation of performance standard and confirmed its weight;meanwhile, the sort of nursing care unite and nursing load were counted accordance with work intensity, risk degree and technological complexity etc and initially built performance management standard system. Results Accordance with the balance score card rationale and internal process, finance, customer, learning and growth four dimensions, a set of performance management standard and was established, including 4 first class indicator, 10 second class indicator and 32 third class indicator were derivative. The internal process, finance, customer, learning and growth factors were 29.44%, 37.56%, 20.32%, and 12.68%respectively. Conclusions Performance management standard system covers objectives of nursing management of Grade three General Hospital, and which is full of an objective, scientific, operational system possibilities, and can be used to multi-angle evaluate nursing performance, dynamic implement nurses management and achieve strategic goals.

Objective To evaluate the relationship between the endogenous protection induced by autophagy against acute lung injury and inflammatory responses in the septic mice.Methods A total of 130 pathogen-free male C57BL/6 mice,aged 6 weeks,weighing 20-25 g,were randomly divided into 5 groups (n =26 each) using a random number table:sham operation group (group S),sepsis group (group Sep),autophagy inducer rapamycin group (group Rap),autophagy inhibitor 3-methyladenine (3-MA) group (group 3-MA),and lysosome inhibitor bafilomycin group (group Baf).Sepsis was produced by cecal ligation and puncture in chloral hydrate-anesthetized mice.Rapamycin 10 mg/kg,3-MA 15 mg/kg,and bafilomycin 1 mg/kg were injected intraperitoneally at 1 h after operation in Rap,3-MA and Baf groups,respectively.Twenty mice in each group were selected and observed for the survival at 7 days after operation,and the 7-day survival rate was calculated.Six mice in each group were selected,and arterial blood samples were obtained at 24 h after operation,the mice were then sacrificed,and lung tissues were obtained for determination of the levels of tumor necrosis factor-alpha (TNF-α),high-mobility group box 1 (HMGB1),interleukin-6 (IL-6),IL-10 and monocyte chemotactic protein-1 (MCP-1) in serum and lung tissues by enzyme-linked immunosorbent assay.The expression of autophagy-related proteins microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ),Beclin-1 and lysosomal-associated membrane protein 2 (LAMP2),and Ras-related protein 7 (Rab7) in lung tissues was detected by Western blot.Results Compared with group S,the 7-day survival rate was significantly decreased,and the levels of TNF-α,HMGB1,IL-6,IL-10 and MCP-1 in serum and lung tissues and LC3 Ⅱ,Beclin-1,LAMP2 and Rab7 in lung tissues were significantly increased in group Sep (P＜0.05).Compared with group Sep,the 7-day survival rate and levels of IL-10,LAMP2 and Rab7 in serum and lung tissues were significantly increased in group Rap and decreased in 3-MA and Baf groups,and the levels of TNF-α,HMGB1,IL-6 and MCP1 in serum and lung tissues were significantly decreased in group Rap and increased in 3-MA and Baf groups,and the levels of LC3 Ⅱ and Beclin-1 in lung tissues were significantly increased in Rap and Baf groups and decreased in group 3-MA (P＜0.05).Conclusion Autophagy-induced endogenous protection against acute lung injury is related to inhibition of inflammatory responses in the septic mice.

Objective To observe the effects of high mechanical index ultrasound contrast on hepatic metastasis of colorectal cancer. Methods Hepatic metastasis models were established by injecting Lovo cells into the spleen of SD rats.This study was divided into control group, microbubble plus ultrasound radiation group simple contrast agent group and simple ultrasound radiation group.Ultrasound contrast agent SonoVue(1 ml/kg) was injected via tail vein, high mechanical index ultrasound contrast (frequency 1.5 MHz,MI 1.7) was performed intermittently for 2 min.After 10 d,the animals were killed and the size and number of hepatic metastasis were compared.Histological pathology and its ultrastructure were observed.Results There were no significant differences between contral group,simple ultrasound radiation group and simple contrast agent group in metastatic rate ( P＞0.05).There were no obvious differences between contral group, simple ultrasound radiation group and simple contrast agent group in cells'ultrastructure by transmission electron microscopy (TEM).The number and size of hepatic metastasis decreased obviously in microbabble plus ultrasound radiation group ( P＜0.01 ), the mitochondrion was swelling and the gaps of endothelial cells were loose. Conclusions High mechanical index ultrasound contrast can inhibit the hepatic metastasis of colorectal cancer.

Objective To explore the burden of diseases among senior people in Shiyan city population by epidemiologic investigation,and to find out the main diseases that threaten their health,so as to provide scientific guide for priority allocation of health resources.Methods Disabilityadjusted life years(DALY) were calculated using the death monitoring statistics of Shiyan during 2007-2009.Results There were 16.11％ of people above 60 years old in Shiyan city,the average mortality and DALY were 20.9％ and 299.5/1000 respectively.Noncommunicable diseases were the main cause of death (89.7％).In the causes of death and burden of disease,cardiovascular diseases (47.7％,105.6/1000),malignant neoplasms (28.2％,66.6/1000),respiratory diseases (7.2％,15.5/1000) were the top three.In addition to nutritional deficiencies,diabetes and genitourinary diseases,DALY caused by other 14 kinds of diseases of male were higher than those of female,and DALY caused by nutritional deficiency was the third cause in female.Conclusions DALY caused by disease among senior people is lower in Shiyan city population than in the national average.Noncommunicable diseases are the foremost disease among senior people,and special attention should be paid to cardiovascular disease and malignant tumor.Gender distribution characteristics should be concerned to prevent and control the disease in the elderly.