Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000 A scan/s, area was 6.0 mm×6.0 mm, and the mode was 512×128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean IogMAR was 0.99±0. 44 (ranged from 0. 15 to 2.00), the mean diameter of macular holes was (942.0± 348. 4)μm(ranged from 171 to 1491 μm), and the mean diameter of IS/OS disruption was (1870. 35±673.2) μm(range from 463 to 3176 μm). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and IogMAR in IMH (P= 0. 038, 0. 002, 0. 000). In eyes with closed macular hole after surgery, the IogMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the IS-OS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the maeular hole closure surgery.

Evidence-Based Medicine ; Humans ; Occupational Diseases ; prevention & control ; Occupational Medicine ; methods

Objective To compare real-time fluorescence quantitative PCR with general PCR in detecting bovine and porcine derived materials in hydrolysate samples.Methods DNA were extracted from hydrolysate samples which prepared by different steps by real-time fluorescence quantitative PCR and general PCR.Results DNA of bovine and porcine could be detected by real-time fluorescence quantitative PCR and general PCR in samples prepared in the processes before enzymolysis solution, but not detected in samples from supermatant to the fourth ultrafiltrate.Conclusion Both real-time fluorescence quantitative PCR and general PCR can be applied to detect the fragments in hydrolysate samples.And real-time fluorescence quantitative PCR has the advantage such as rapid,convenient, non-environment-polluted, good repeatability, which improves the quality and efficiency.

Objective To evaluate the intraoperative opioid?sparing effect of different duration transcutaneous electrical acupoint stimulation ( TEAS ) in video?assisted thoracoscopic lobectomy. Methods Seventy?five patients, aged 18-64 yr, weighing 40-96 kg, of ASA physical status Ⅰ or Ⅱ, scheduled for elective video?assisted thoracoscopic lobectomy under general anesthesia, were randomly divided into 3 groups (n=25 each) using a random number table: control group (group C), 30 min of stimulation before induction of anesthesia group ( group B) , and stimulation throughout surgery ( group T) . In group B, the patients received TEAS ( frequency 2∕100 Hz ) on acupoints Xinshu ( BL15 ) , Feishu (BL13), Neiguan (PC6), Hegu (LI4) on the operated side starting from 30 min before induction of anesthesia until the beginning of induction, and the intensity was the maximum current that could be tolerated. The intensity for Neiguan ( PC6) and Hegu ( LI4) was 6-12 mA, and for Xinshu ( BL15) and Feishu ( BL13 ) was 9-18 mA. In group T, the patients received TEAS on the four acupoints mentioned above starting from 30 min before induction of anesthesia until the end of surgery. The patients had the electrodes applied, but received no stimulation in group C. After anesthesia was induced with propofol?sufentanil?cisatracurium, double lumen endotracheal tube was inserted. Propofol was given by target?controlled infusion to maintain BIS value within the range of 40-60. Cisatracurium was infused continuously to facilitate muscle relaxation. The infusion rate of remifentanil was adjusted to maintain analgesia nociception index value within the range of 50-70. The intraoperative consumption of remifentanil ( the intraoperative consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1∶ 10) was recorded. Results Compared with group C, the intraoperative consumption of remifentanil was significantly decreased in B and T groups. The intraoperative consumption of remifentanil was significantly lower in group T than in group B. Conclusion TEAS on Xinshu ( BL15 ) , Feishu (BL13), Neiguan ( PC6) and Hegu acupoints throughout surgery and for 30 min before induction of anesthesia significantly reduces intraoperative opioid consumption in the patients undergoing video?assisted thoracoscopic lobectomy, while TEAS throughout surgery provides better effect.

Objective To primarily investigate the clinical value of analgesia/nociception index (ANI) in evaluating the analgesic effect during lobectomy performed via video-assisted thoracoscope.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,weighing 45-80 kg,undergoing elective lobectomy performed via video-assisted thoracoscope,were enrolled in this study.After induction of anesthesia with propofol,sufentanil and cisatracurium,patients received double lumen endotracheal intubation.Anesthesia was maintained with targetcontrolled infusion of propofol,and iv infusion of remifentanil and cisatracurium.The concentration of propofol was adjusted to maintain the bispectral index (BIS) value in the range of 40-60.ANI,HR,systolic blood pressure (SBP),diastolic blood pressure (DBP) and BIS value were recorded within 5 min before and after the predefined time points including posture change between lateral and supine position,ventilatory pattern change between onelung and double-lung ventilation,skin incision and trocars insertion,lymph node dissection and pleural lavage.At skin incision and during trocars insertion,lymph node dissection and pleural lavage,the development of hemodynamic responses (increase in HR and SBP ＞ 20％ of baseline value) were recorded.Results The incidence of hemodynamic responses was 100％ at skin incision and trocars insertion,and 84 ％ during No.4,7,10 groups of lymph node dissection and after pleural lavage and difference was found in ANI during these stimuli.ANI was significantly decreased within 5 min after skin incision,trocars insertion,No.4,7,10 groups of lymph node dissection and pleural lavage than that before the procedures (P ＜ 0.05).The BIS value was maintained at 40-60,and no significant changes were found between before and after the procedures (P ＞ 0.05).No significant changes were found in ANI,HR,SBP,and DBP between before and after the changes of posture and respiratory pattern (P ＞ 0.05).Conclusion ANI can be used to evaluate the analgesic effect during lobectomy performed via video-assisted thoracoscope in patients and is unaffected by the changes of posture and ventilatory pattern.

A sensitive, rapid and specific liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method for quantification of gabapentin in human plasma has been developed. After a single plasma protein precipitation with methanol, gabapentin and metformin (internal standard) were chromatographed on a Inertsil ODS-3 column (50 mm x 2.1 mm ID, 3 microm) with mobile phase consisting of methanol-0.2% formic acid aqueous solution (80:20, v/v) at a flow-rate of 0.2 mL x min(-1). Electrospray ionization (ESI) source was applied and operated in the positive ion mode. Multiple reaction monitoring (MRM) mode with the transitions of m/z 172 --> m/z 154 and m/z 130 --> m/z 71 were used to quantify gabapentin and metformin, respectively. The run time was 2.2 min. The linear calibration curve was obtained in the concentration range of 40.8-8.16x10(3) ng x mL(-1). The lower limit of quantification was 40.8 ng x mL(-1). The intra- and inter-day precision (RSD) was less than 12%, and the accuracy (RE) was within +/-6.4% calculated from quality control (QC) samples. The method was used to determine the concentration of gabapentin in human plasma after a single oral administration of 600 mg gabapentin capsule to 20 healthy male Chinese volunteers. The method was proved to be selective, sensitive, rapid and suitable for pharmacokinetic study of gabapentin in human plasma.

Objective To summarize clinical experience of emergent surgery for severe liver trauma with rupture of major blood vessels. Methods The clinical data of 12 cases suffering from severe liver trauma with rupture of perihepatic and intrahepatic large blood vessels were retrospectively analyzed. These cases were from Dec 2000 to May 2008. All the cases underwent emergency operation, 6 cases were treated with liver lobectomy: among those 1 case with right posterior lobe liver resection, 1 case with irregular right lobe liver resection, 3 cases with left hemihepatectomy, and 1 case with left lateral lobectomy. Seven cases with rupture of major blood vessels were treated by repair or ligature and/or packing including repair of posthepatic inferior vena though the middle fissure in 2 cases, and through retrahepatic space in one case, interrupted suture of the portal vein in 2 cases, interrupted suture of the right hepatic veins in 2 cases. Mattress suture was applied to the ruptured hepatic veins in 7 cases including mattress suture of the branch of right hepatic vein and middle hepatic vein in 1 case, mattress suture of right hepatic vein in 1 case, suture of middle hepatic vein in 2 cases, and suture of left hepatic vein in 3 cases. One case was treated with ligation of hepatic artery and 3 cases with gauzes packing. Results Among all the 12 cases, 9 cases were cured, 3 cases died: two were caused by severe trauma together with hemorrhagic shock, one by sever brain injury together with hemorrhagic shock. Conclusions Prompt operation, precise stop bleeding and correct operation style are the key for successful rescue of patients suffering from severe liver trauma and massive bleeding.

Objective To analyze characteristics of severe liver trauma and efficacy of different surgical procedures. Methods Clinical data of 109 patients with severe liver trauma treated in the recent 10 years were retrospectively analyzed. Debriding suture was performed in 32 patients, gauze tamponade in 5, debridement hepatectomy in 59 and anatomical hepatectomy in 13 patients. Results In all the 109 patients, 92 were cured and 17 died. The dead patients included 3 with grade Ⅲ trauma,9 with grade Ⅳ trauma, and 5 with grade V trauma. Among the dead patients, there were 3 patients with simple liver injury (17.6%) and 14 with associated injury (82.4%). Conclusion Right hepatic serious damage is the main type of severe liver trauma and is always complicated with associated injury and needs emergency treatment. Application of the most appropriate surgical approach according to the traumatic condition is important to promote the successful rate of treatment.

Objective To investigate and analyze the postoperative progression of ossification of the patients with ossification of the posterior longitudinal ligament (OPLL) on cervical spine. Methods From Jaunary 2001 to December 2007, 95 postoperative patients with cervical OPLL were followed and analyzed retrospectively. There are 72 males, 23 females, with the average age of 56.3 years (range, 40-73years). The follow-up time was from 1 to 6 years, average 3.1 years. Among them 36 patients were performed with anterior cervical corpectomy, fusion with titanium mesh and fixed with cervical plates, others treated with posterior cervical laminectomy and fixation. 2 of the 95 cases were performed anterior and posterior combined operation. Clinical data, X-rays, CT and MR images and progression of ossification, were measured and analyzed in details .The relationships between the progression of ossification and relative factors, as gender, age, C3 ossified involved, T-OPLL, OPLL-type, time of follow-up, surgical approach, Japanese Orthopaedic Association (JOA) scores and improvement rate of JOA scores, were analyzed. Results Progression of ossification in 39 cases among the 95 followed postoperative OPLL patients, 28 men and 11 women, average age 55.9 years, range 41-71 years. The age of progressed patients included 12 cases of ≤49 years, 12of 50-59 years, 12 of 60-69 years and 3 of ≥70 years. 35 patients were operated by posterior approach and only 4 treated with anterior operation. According to the standard of the progression of ossification that 2 mm in the length or/and thickness, there are 4 cases progressed only in length, 2 only in thickness, other 33 patients both the length and thickness. Progression of length is from 2mm to 20mm (average 7.74±4.71). But thickness is progressed from 2 mm to 6 mm (average 2.67±1.51). From 1 to 3 years follow-up time it appeard as a downtrend about the progression of ossification. But it may appear an uptrend from the 4th year. JOA score and improvement rate of the JOA score were almost improved to the high-point in three years. And according to the statistic data there are obvious relationship between progression of ossification with age, surgical approach and C3 ossified involved. Conclusion There is a high rate of postoperative ossification progression in cervical OPLL patients. Cervical OPLL patients with C3 ossification involved, performed with posterior laminectomy and those young at surgery may have higher rate of progression of the ossification. The JOA score and improvement rate of the JOA score were little influenced by the progression of the OPLL during the short and intermediate-term follow-up.