Ocular surface disorders can be caused by the drug-derived toxicity,adverse effect and abuse of eye drops,and usually these disorders present with unspecific and untypical clinical findings.So the eye abnormality induced by topical administration of eye drops often is confused with some corneal inflammatory diseases.In addition,pathogenic mechanisms vary widely due to the different types of eye drops.Therefore,difficulty of diagnosis and poor curative effect often is a challenge for us.Ophthalmologist should be aware of the toxicity derived eye drops on ocular surface.Several noticeable problems of diagnosis and treatment of drug-derived keratopathy were elaborated in this paper.

Objective To explore the diagnosis and Fogarty catheter embolectomy operation management of acute arterial embolism in the extremities.Methods The clinical data of 87 cases of acute arterial embolism in the extremities treated by Fogarty catheter was ana- lyzed retrospectively,Results All cases were diagnosed through asking patient history and symptom,physical examination and the check of color Doppler while the results were proved by operation.No one case received vasography.After operation,78 cases blood stream of limb had been resumed and cure rate of 87.6% was achieved while 4 cases improved(4.5%),and no occurrence of ischemic necrosis and amputated ex- tremity.5 cases(5.6%)received amputation at the relative level and there were 2 cases(2.3%)of perioperative death.Those cases who re- ceived operations within 48 hours from the time of morbidity achieved cure rate of 100%,while those cases more than 48 hours achieved cure rate of 47.6%,improvement rate of 19.0%,amputation rate of 23.8% and mortality of 9.6%.Conclusion First,Ultrasound Doppler exami- nation should be taken for avoidance of misdiagnosis when acute extremity arterial embolism is suspected.Second,The key Intraarterial embo- lectomy using Fogarty catheter is an effective method for the treatment of acute arterial embolism in the extremities,is significant in application,Third,as soon as the diagnosis is established,embolectomy with Forgarty catheter must be carried out to avoid clot extension and necrosis of the extremity.Satisfactory therapeutic efficacy can be got,if the patient receive operation within 48 hours from onset.

BACKGROUND: Bag-1 is a multifunctional and anti-apoptotic gene. Its anti-apoptotic ability is enhanced when binding to bcl-2 to form a complex.Now it is considered as a predictive biomarker for the early diagnosis of breast cancer. However, whether it is useful in the assessment of the prognosis of breast cancer is still elusive.OBJECTIVE: To explore the expression of bag-1 in breast cancer and its role for prognosis.DESIGN: A controlled study with breast cancer, benign breast tumor and normal breast tissues as subjects.SETTING: The Vascular and Endocrine Surgery Department of Xijing Hospital of the Fourth Military Medical University of Chinese PLA.MATERIALS:Totally 100 breast cancer specimens were obtained form May 1995 to May 2000. Ten benign breast tumor and 10 normal breast tissues were used as control. All the specimens were paraffin-embedded and came from the Pathological Department of Xijing Hospital Affiliated to Fourth Military Medical University of Chinese PLA.METHODS: Immunohostochemical strept avidin-biotin complex(SABC) method was adopted to detect bag-1 expression in these specimens.pression levels of bag-1.RESULTS: The positive expression rate of bag-1 in breast cancer (85%) was significantly different form those of benign breast tumor (10%) and normal breast (10%) (χ2= 29.98, P = 0.00). While the positive expression rates in breast cancer of different stages (stage Ⅰ, stage Ⅱ and stage Ⅲ ) were 88%, 82% and 88%, respectively, which has no significant difference (χ2 = 0. 61, P = 0.75) . In duct carcinoma, lobular carcinoma and special carcinoma, bag-1 positive expression rate was 86%, 85% and 80%,which was also no significantly different (χ2 =0.16, P =0.95). In the 94followed patients, the 5-year survival rate of positive bag-1 expression was 79% and that of negative bag-1 expression was just 9%. The difference was significant (χ2 = 0. 07, P = 0.04).CONCLUSION: High bag-1 expression exists in breast cancer and its level is not associated with the clinical stages or pathological types of the cancer.Therefore, bag-1 may be used as a predictive marker for the prognosis of breast cancer.

Background Pupil atresia increases the difficulty of cataract surgery.The improper enlarging pupil will lead to many complications.The appropriate method of pupil dilation is very important to improve the postoperative effect.Objective This study was to evaluate the pupillary function after manually enlarged pupil to different sizes for pupil atresia complicated cataract.Methods A retrospective case-controlled study was designed.Thirty-eight eyes of 30 cases suffered from pupil atresia complicated cataract induced by chronic uveitis were enrolled in Shandong Eye Institute from May 2006 to May 2012.The eyes underwent pupil forming and phacoemulsification and assigned to the pupil enlarged to ≥6.0 mm group (15 eyes) and 4.5-5.5 mm group (23 eyes).The fibrosis membrane at pupil zone was removed,and the fibrosis strip at pupil collar was cut evenly by 23G intraocular microscissors as zigzag shape.Then the pupil was enlarged in multipoint by a pair of left and right iris hook from the main and lateral incisions.The pupils of 15 eyes in the pupil enlarged to ≥6.0 mm group were dilated above 6.0 mm and 23 pupils in the 4.5-5.5 mm group were dilated to 4.5-5.5 mm and followed by routine phacoemulsification and foldable intraocular lens implantation.Topical and systemic corticosteroids and nonsteroidal anti-inflammatory drugs combined topical mydriatic were applied before and after operation.The pupil diameter,light reflex and photophobia symptom in postoperation were compared between the two groups.The visual acuity before and after operation and intra-and post-operative complications were recorded.This study was approved by Ethic Committee of Shandong Eye Hospital,and written informed consent was obtined from each patient before operation.Results The pupil diameter in the pupil enlarged to ≥6.0 mm group was dilated to (6.9±0.4) mm and that of the 4.5-5.5 mm was dilated to (5.1 ±0.3) mm intraoperatively,with a statistical significance between them (t =16.100,P =0.000).Three months later,the pupil diameter in the pupil enlarged to ≥ 6.0 mm group was (4.9 ±0.4)mm,with different degrees of lacerated pupillary margins,and that in the pupil enlarged to 4.5-5.5 mm group was (3.5 ±0.5) mm,with rare lacerated pupillary margins,showing a statistically significant difference (t =9.820,P =0.000).The unresponsive or obtuse light reflex in the pupil enlarged to ≥6.0 mm group was significantly higher than in the pupil enlarged to 4.5-5.5 mm group(11 eyes vs.6 eyes) (x2 =8.200,P =0.005).The subjective photophobia symptom of 2-3 grades in the pupil enlarged to ≥6.0 mm group was in 12 eyes,which was higher than that in the pupil enlarged to 4.5-5.5 mm group (2 eyes) (H=19.840,P=0.000).The iris haemorrhage were seen in 3 eyes in the pupil enlarged to 4.5-5.5 mm group and 7 eyes in the pupil enlarged to ≥6.0 mm group (x2 =5.290,P=0.030).The visual acuities of the operated eyes in the two groups improved at different degrees.Conclusions Approximate physiological pupil and good visual quality can been obtained by manual releasing and enlarging pupil to less than 5.5 mm evenly during the surgery for pupil atresia complicated cataract induced by chronic uveitis.

Background Eyes with filamentary keratitis present with serious clinical symptoms.This disease is easy to relapse and the treatment is tricky.At present,its pathogenesis is still unclear,and few works were done on filamentous composition.Objective This study was to analyze the composition of corneal filament by imageological and histopathological method,and discuss the formation mechanism of filamentary keratitis.Methods Eighty-eight eyes of 82 cases who suffered from filamentary keratitis were collected in Shandong Eye Hospital between January 2008 and January 2011.The etiologies of the patients were classified and the clinical data were recorded.Firstly,the corneal filiform strip was detected by laser scanning confocal microscopy (LSCM),and the corneal structure was examined by high-definition optical coherence tomography (HD-OCT).Then the composition of filamentary strip was analyzed by Giemsa and Masson trichrome staining of stretched preparation of filiform strip.Results Etiological study showed that filamentary keratitis occurred after penetrating keratoplasty in 40 eyes,after cataract surgery and photorefractive keratectomy (PRK) in 18 eyes,dry eye and neural dystrophic corneal disease in 14 eyes,acute conjunctivitis in 10 eyes.HD-OCT revealed that filament lesion developed to Bowman layer.Filament was composed of epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement under the LSCM,and epithelial cells,inflammatory cells and fibrous tissue were seen in the strip core.Giemsa staining exhibited that filament contained corneal epithelial cells,inflammatory cells,mucus and dark blued strip core with helical arrangement.Masson trichrome discovered that the strip core was red fibrous tissue surrounding by blue mucus.Conclusions Epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement are the main elements of filament in filamentary keratitis.The lesion can reach Bowman layer.The results contribute to reveal the formation mechanism of corneal filament and assist treatment.

OBJECTIVETo explore the neuroprotective effect and mechanism of picroside II on extracellular regulated protein kinases1/2 (ERK1/2) signal transduction pathway in cerebral ischemia injuryrats. METHODS The middle cerebral artery occlusion (MCAO) model was established by inserting a monofilament into middle cerebral artery. Totally 96 successfully modeled Wistar rats were divided into the modelgroup, the treatment (picroside II) group, the Lipopolysachcaride (LPS) group, and the U0126 group according to random digit table. Each group was further divided into 3 subgroups, i.e. 6, 12, and 24 h sub-groups. Picroside II (20 mg/kg) was peritoneally injected to rats in the treatment group 2 h after ischemia.LPS (20 mg/kg) and Picroside II (20 mg/kg) were peritoneally injected to rats in the LPS group 2 h after ischemia. U0126-EtOH (20 mg/kg)and Picroside II (20 mg/kg) were peritoneally injected to rats in the U0126group 2 h after ischemia. Equal volume of normal saline was peritoneally injected to rats in the control groupand the model group. The neurobehavioral function was evaluated by modified neurological severity score(mNSS) test. The structure of neurons was observed using hematoxylin-eosinstaining (HE) staining. Theapoptotic cells were detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The expression of phosphorylated extracellular signal-regulated protein kinase1,2 (pERK1,2) in cortex was detected using immunohistochemistry (IHC) and Western blot.

RESULTSAfter cerebral ischemia injury neurological impairment score increased, the damage of neuron in the cortical area was aggravated, apoptotic cells increased in the model group as time went by. The expression of pERK1/2 increased more significantly in the model group than in the control group (P <0.05). The damage of neuron in the cortical area was milder, while apoptotic cells decreased, the expression of pERK1f2 obviously decreased more in the treatment group and the U0126 group (P < 0.05). The early damage of neuron in the cortical area was more severe, apoptotic cells and the expression of pERK12 were comparatively higher in early stage of the LPS group, but the expression of pERK1/2 was somewhat decreased in late stage.

CONCLUSIONSActivating ERK12 pathway could mediate apoptosis and inflammatory reactions of neurons after cerebral ischemia injury. Picroside II could protect the nerve system possibly through reducing activation of ERKI2 pathway, inhibiting apoptosis of neurons and inflammation reaction.

Animals ; Apoptosis ; Brain Ischemia ; drug therapy ; Cinnamates ; pharmacology ; Infarction, Middle Cerebral Artery ; drug therapy ; Iridoid Glucosides ; pharmacology ; MAP Kinase Signaling System ; drug effects ; Neurons ; pathology ; Neuroprotective Agents ; pharmacology ; Random Allocation ; Rats ; Rats, Wistar

Objective To explore role of 64-slices spiral CT in differetiation of acute chest pains.Methods Thirty six patients with acute chest pains were performed 64-slices spiral CT chest angiography.Two-dimensional and three-dimensional reconstruction was performed in all patients by means of multiplanar reconstruction(MPR)(coronal,sgittal oblique),curved planar reformation(CPR), maximum intensity projection(MIP),and volume rendering(VR).All images were blindly reading by two experienced radiologist.DSA were performed at the same time in 16 cases.Results The coronary artery branches,pulmonary artery and aortic artery in all patients were showed clearly,The acute myocardial infarction were showed in 10 cases,The pulmonary artery embolism in 14 cases,The aortic dissection in 6 cases respectively,The Coronary embolism in One case ,pneumothorax In One case The constrictive pericarditis in 1 case respectively.Normal findings in 4 cases.Conclusion 64-slices spiral CT is a useful and noninvasive examination in acute chest pain.

BACKGROUND: Limb negative pressure treatment can dilate limb vessels and improve terminal microcirculation. P-substance has strong vasodilative activity and is involved in the sensation of the skin to traumatic stimulation and the modulation of local vascular function.OBJECTIVE: To observe the influence of limb negative pressure on cutaneous P-substance immunoreactive nerve fibers in dogs with peripheral arterial occlusive disease.DESIGN: Randomized controlled experiment.SETTING: The 3rd Department of General Surgery, Xijing Hospital Affiliated to the Fourth Military Medical University of Chinese PLA.MATERIALS: This experiment was conducted at the Animal Laboratory of Xijing Hospital Affiliated to the Fourth Military Medical University of Chinese PLA between April 2003 and May 2004. Totally 17 healthy hybrid dogs were randomized into 3 groups, namely, treatment group of 10 dogs,non-treatment group of 5 dogs, and normal control group of 2 dogs.INTERVENTIONS: Negative pressure treatment on affected limbs: After superficial anesthesia, the left hindlimbs of the animals were put into the home-made negative cabin for negative pressure treatment with pressure designed as -12kPa, for 15 minutes, once a day for consecutive 10 days.[1] Treatment group: The left hindlimb ischemic model was prepared 14days before starting 10-day negative pressure treatment; after that the animals were subjected to infusion, the skin of the 2nd toe of affected limbs, as well as L1-5 spinal cords and dorsal root ganglion were obtained for immunohistochemical (IHC) staining. Meanwhile prostaglandin E1 immunoreactive nerve fibers were detected. [2] Non-treatment group: The animals received the same treatment and examination as treatment group except for negative pressure. [3] Normal control group: No ischemic model was prepared or negative pressure treatment was given except for IHC staining.MAIN OUTCOME MEASURES: Changes of cutaneous P-substance immunoreactive nerve fiber in each group. RESULTS: Totally 17 dogs entered the result analysis. Changes of cutaneous P-substance immunoreactive nerve fibers: The cutaneous P-substance immunoreactive nerve fibers in dermis connective tissues and layer vessels were reduced in treatment group compared to those in non-treatment group[(24.70±4.6), (43.49±6.3) μm/mm2, P ＜ 0.01], but still higher than those in control group [(18.10±5.4) μm/mm2, P ＜ 0.01]; dermis P-substance immunoreactive nerve fibers in non-treatment group were more than those in normal control group (P ＜ 0.01), with P-substance immunoreactive nerve fibers increased and deeply stained in dermis connective tissues and small vessels. In contrast, P-substance immunoreactive nerve fibers were not observed in the horny layer but in the dermis of the toe in normal control group.CONCLUSION: Results of the present study suggest that limb negative pressure can enhance P-substance release from cutaneous sensory nerve fibers.

OBJECTIVETo observe the effects of Chailing Decoction (CD) on transforming growth factor-beta1 (TGF-beta1), connective tissue growth factor (CTGF), renal cell apoptosis and proliferation in rats with chronic cyclosporine A nephropathy (CCN), and to explore its possible mechanism for inhibiting renal fibrosis.

METHODSThe CCN rat model was prepared using oral administration of cyclosporine A (CsA, 30 mg x kg(-1) x d(-1)). Meanwhile, they were treated with CD (3 g x kg(-1) x d(-1)) by gastrogavage. The serum blood urea nitrogen (BUN), serum creatinine (SCr), and creatinine clearance rate (CCr) were measured by the end of the fourth week of the experiment. The kidneys were taken out on the next day. The degree of renal fibrosis was detected using Masson staining. The protein and gene expressions of TGF-beta1, and CTGF were observed using immunohistochemical assay and RT-PCR. The renal cell apoptosis rate and the proliferation index were detected by flow cytometry.

RESULTSCompared with the control group (BUN: 6.123 +/- 0.588 mmol/L; SCr: 75.654 +/- 8.196 micromol/L; CCr: 0.539 +/- 0.169 mL/min), the renal function of the model group (BUN: 11.600 +/- 1.437 mmol/L; SCr: 101.985 +/- 10.809 micromol/L; CCr: 0.272 +/- 0.060 mL/min) obviously declined (P < 0.01). The collagen deposition in the renal interstitial area significantly increased. The protein and mRNA expressions of TGF-beta1, and CTGF in the tubular epithelial cells and the mesenchymal cells were significantly enhanced (P < 0.01). The cell proliferation index and the apoptosis rate both increased, but the ratio of apoptosis to proliferation (0.317 +/- 0.059) decreased more than that in the control group (0.680 +/- 0.150, P < 0.01). After treatment by CD, the renal function (BUN: 7.340 +/- 0.857; SCr: 84.923 +/- 10.627; CCr: 0.405 +/- 0.081) was significantly enhanced (P < 0.05, P < 0.01), the collagen deposition decreased, the high protein and mRNA expressions of TGF-beta1 and CTGF were down-regulated (P < 0.01), the ratio of apoptosis to proliferation increased (0.650 +/- 0.092, P<0. 01).

CONCLUSIONCD could improve the renal function of CCN model rats, inhibit the expressions of TGF-beta1 and CTGF, and recover the balance between the renal cell apoptosis and proliferation by inducing cell apoptosis and inhibiting cell proliferation, thus delaying the renal fibrosis process.

Animals ; Apoptosis ; drug effects ; Cell Proliferation ; drug effects ; Connective Tissue Growth Factor ; metabolism ; Cyclosporine ; adverse effects ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Fibrosis ; Kidney ; drug effects ; metabolism ; pathology ; Kidney Diseases ; chemically induced ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism