BACKGROUND: About one fourth of diabetic patients suffer from diabetic retinopathy(DR) and has greatly impacted their quality of life due to the decreased vision. Social support plays important role on rehabilitation of patients.OBJECTIVE: To analyze the relationship between social support and quality of life(QOL) in patients with diabetic retinopathy in order to direct clinical practice and improve the patients' QOL.DESIGN: Cross-sectional study based on patients with diabetic retinopathy.SETTING: Department of Ophthalmology, General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: Totally 81 patients admitted into Department of Ophthalmology, General Hospital of Nanjing Military Area Command of Chinese PLA with diabetic retinopathy during January 2002 to May 2003 were selected. Inclusion criteria: suffer from diabetic retinopathy and willing to attend this study. Exclusion criteria: people with other complications (hypertension, kidney disease) . The patients were divided into two groups according to vision: 28 cases in the group with binocular vision between 0.06 -0. 1; 53 cases in the group with vision less than 0. 05.METHODS: Investigation was conducted to the two groups from three dimensions including objective support, subjective support and usage in order to assess the social support to patients with diabetic retinopathy of different vision. And modified quality of life index (MQLI) was used to assess the QOL in patients with diabetic retinopathy that covered 5 dimensions: somatic health, mental health, social function, self-image and material base.MAIN OUTCOME MEASURES: The total score of social support and QOL of patients with diabetic retinopathy, score of somatic health, mental health,social functions and material base as well as the correlations among them.RESULTS: The total score of social support, score of objective support factor, subjective support factor and usage factor in roup with vision between 0.06 and 0. 1 were much higher than those in group with vision less than 0.05 ( P < 0.01 ). For patients with diabetic retinopathy, the social support had strong correlation with total score of QOL and factor score of other dimensions except of self-image( P < 0.05 or P < 0.01).CONCLUSION: Social support is an important factor that impacts QOL to patients with diabetic retinopathy. It will improve their QOL by reinforcing the social support.

Objecitve To conclude the clinical manifestation of Fournier's gangrene (FG) and its emergency treatment.Methods From 2006 to 201 1,12 patient were involved in the study,all had received debridement,wide spectrum antibiotics and support therapy,the clinical manifestation,treatment choice and prognosis were analyzed retrospectively.Results All patients were male with 67.7 year-old mean age.Initial lesions were all in scrotal skin,an average procedures of each patient was 3.5,mean hospitalization days was 29.7 days.Surgical wound was healed by left scrotal skin in all cases,2 cases with huge urethra defect were received perineostomy.Ten cases were survived with 57-months follow-up and mortality was 16.7％.Conclusions Fournier is one of emergency disease of Urology.Its mortality is still high.Intensive care and appropriate anti-biotic therapy combined with surgical treatment is the key of FG's management.

Objective Concluding the clinical feature and prognosis of primary testicular lymphoma to improve the understanding of this disease.Methods During 1995 and 2010,17 cases of primary testicular lymphoma treated in Beijing Friendship Hospital of Capital Medical University were retrospectively analyzed of its clinical features,diagnosis,treatment and prognosis.Results Seventeen patients with a mean age of 68 years complained the testicular sohd mass as their first symptoms.The mean tumor diameter was 4.7 cm,and all patients underwent orchidectomy,and testicular non- Hodgkin's lymphoma was confirmed by pathologic examination.Fourteen cases were diffuse large B cell type and 3 cases were anaplastic large cell type.The clinical stage of all the patients was IE.Fourteen cases were followed up (3 cases were lost)with mean follow-up time of 37.8 months by outpatient interview and telephone,all patients were treated with CHOP chemotherapy,and some of them were combined with rituximab and preventive lowdose pelvic radiotherapy.Five cases died of other chronic medical complications,1 case with contralateral testicular metastasis received surgery again.There were 9 tumor free survival cases in total.Conclusion Primary testicular lymphoma is rare and more common in older men.Postoperative pathologic diagnosis is gold standard.The systemic treatment and individual therapy is the first choice for primary testicular lymphoma.

Objective To evaluate whether the unidirectional barbed suture is safety and efficiency enough for laparoscopic partial nephrectomy.Method From March 2013 to March 2014,27 patients with renal mass have been involved into this study and divided into 2 groups wsing a lottery.Group A used Coated Vicryl in renorrhaphy after LPN,and group B used unidirectional barbed suture.All patients underwent LPN preformed by single group of surgeons.Perioperative and postoperative indicators were compared in two groups.Result It is identical in age,BMI,tumor size,R.E.N.A.L nephrometry scoring system between 2 groups.However,using barbed suture has significantly shortened in warm ischemia time (WIT).The postoperative indicators,such as blood loss,hospital stay and surgery complication has no significantly difference in two groups.Conclusion The unidirectional barbed suture is safety and efficiency using in LPN which can shorten WIT significantly.

Objective To detect the relationship between plasma B-type natriuretic peptide(BNP) and left ventricular function in elderly patients with maintenance hemodialysis (MHD). Method Plasma BNP concentration were measured in 50 MHD patients (MHD group) and 30 healthy controls (control group). Echocardiographic examinations were performed including left ventricular ejection fraction (LVEF). Results The median plasma BNP level in MHD group before and after hemodialysis was 213.5 ng/L and 110.2 ng/L, and obviously higher than that in control group (20.2 ng/L) (P<0.01). Spearman rank correlation showed that plasma BNP level was significantly negatively correlated with LVEF (r=-0.4357, P< 0.05). The median plasma BNP level in the patients with LVEF < 50% before and after hemodialysis was 386.5 ng/L and 232.0 ng/L, significantly higher than that in the patients without left ventricular dysfunction (LVEF≥50%) (59.7 ng/L and 29.1 ng/L)(P<0.01). Conclusions The level of BNP may reflect dynamic change of left ventricular function in MHD patients. It can help to diagnose and treat cardiovascular disease in MHD patients early.

Objective To explore the different operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.Method A retrospective analysis was performed on 48 cases of native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney,including 14 cases receiving open surgery (open surgery),22 cases receiving laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision (oblique incision group) and 12 cases receiving modified endoscope assisted Plunk technique (Plunk group).The operating time,amount of bleeding and blood transfusion during operation,recovery of intestinal function,time of indwelling drainage tube and wound suture,the total cost of hospitalization,the hospital stay and the incidence of complications were comparatively analyzed.Result The operating time in open group was shortest.Group of Pluck is better than other groups in the aspects of Time of wound suture and intestinal function time in shorter in Plunk group than the rest two group (P＜0.05),and amount of bleeding and incidence of complication in Plunk group were higher than oblique incision group (P＜0.05).The incidence of complications and amount of bleeding were decreased significantly as compared with the rest groups (P＜0.05).Conclusion The mode of the laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision has the advantages of high security,minimal invasion and satisfactory treatment effect.It is especially suitable for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.

Objective To evaluate the effects of a comprehensive intervention including regular aerobic exercise and health education on knowledge,attitude,belief,practice (KAP) scores,body mass index (BMI),waist circumferences,blood pressure,serum glucose and lipid levels in middle-aged and elderly people with overweight and obesity.Methods Three resident communities were chosen randomly from Wangdingdi community in Nankai district in Tianjin.Totally 125 overweight people were involved in this study,62 and 63 people were randomly assigned to intervention group and control group respectively.The members of intervention group were asked to participate in aerobic exercise and health education program 3 times per week within 6 months.And control group members received no intervention.Then to evaluate the effects of intervention of regular aerobic exercise and health education by physical examination and questionnaire.Comparison between intervention group and control group was performed using a repeatedmeasures analysis of variance.Results The comprehensive intervention resulted in significant improvement of the KAP scores [13.82 (95％CI:12.42-15.23)] and high-density lipoprotein cholesterol [0.22(95％ CI:0.17-0.28) mmol/L] and reductions in intervention group in body mass index [-0.47 (95％ CI:-0.58-0.36) kg/m2],waist circumference [-4.00 (95％ CI:-5.01--2.99) cm],systolic blood pressure [-11.69 (95％ CI:-13.84--9.55) mmHg] (1 mmHg=0.133 kPa),fasting plasma glucose [-1.21 (95％ CI:-1.55--0.88) mmol/L],triglyceride [-0.06 (95％ CI:-0.25-0.13) mmol/L],low-density lipoprotein cholesterol [-0.48 (95％ CI:-0.62--0.34) mmol/L].Conclusion Regular aerobic exercise and health education program in community can successfully reduce body mass index,waist circumference and some other risk factors related to overweight and obesity.It is effective to improve awareness,physical fitness,change lifestyle for middle-aged and elderly people in the community.

Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor.Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups.In the modified technique group (group A,n =10),tumor was resected until the ureteral orifice was exposed.Then,a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire.In control group (group B,7 cases),after ureteral orifice exposed,the guide wire and ureteral stent was placed with cystoscopy.The demographic,oncological baseline and operative factors were evaluated between two groups.Results There was no difference in tumor grade and maximum diameter between two groups (P ＞ 0.05).The operation time in group A was significantly shorter than that in group B [(39.5 ± 14.8)min vs (59.3 ± 16.2) min,P =0.020],and the intraoperative vision clarity score was better in group A as well [(7.7 ± 1.3) vs (5.9± 1.2),P =0.010].There was no statistical difference between the two groups in the complication.Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement.

[Abstract ] Objective The role of serum Pygo2 expression in children with non-alcoholic fatty liver disease(NAFLD) in the disease process and whether it can be used to evaluate the degree of liver fibrosis still remain unknown .The article aimed to detect Pygo 2 expression in the peripheral blood of children with NAFLD and ana-lyze its relationship with traditional serum hepatic fibrosis index in or-der to evaluate the clinical significance of Pygo 2 measurement in chil-dren with NAFLD . Methods We enrolled 120 cases of childhood obesity and 18 healthy controls in Anhui Provincial Hospital and the First Affiliated Hospital of Nanjing Medical University from September 2014 to February 2016.The cases of childhood obesity were di-vided into simple obesity group ( n=44, no diffuse fatty liver under liver ultrasound detection ) , NAFL group ( n=35, diffuse fatty liver with normal liver function under liver ultrasound detection ) and NASH group ( n=41, diffuse fatty liver with abnormal liver function under liver ultrasound detection ) .The peripheral serum was collected from all patients and healthy controls .ELISA was used to detect serum Pygo2 expression and radioimmunoassay was used to detect the serum hyaluronia acid (HA), procollagen type Ⅲ(PCⅢ), pro-collagen type Ⅳ(CⅣ) and laminin(LN) levels.Finally the serum ALT and γ-GT levels were measured with totally automatic enzymat-ic method. Results Pygo2 expression in NAFL group [52.1(12.3)μg/L] and NASH group[78.3(50.0)μg/L] increased signifi-cantly compared with simple obesity group [43.2(18.7)μg/L](P<0.05).Pygo2 expression in NASH group increased significantly compared with control group [41.7(16.8)μg/L] and NAFL group (P<0.001).The serum hepatic fribrosis and inflammation markers ( HA, PC, ALT, C III and IV gamma-GT) levels gradually increased in the obese children .There were statistically positive correla-tions between serum Pygo2 and HA, PCⅢ, CⅣ, ALT or γ-GT (P<0.001).In particular, more significant positive correlations were found between serum Pygo2 and HA, CⅣor γ-GT (r=0.708, P<0.001;r=0.589, P<0.001;r=0.674, P<0.05). Conclusion The degree of liver fibrosis worsens with the increase of Pygo 2 expression and Pygo 2 is in remarkable correlation with conventional he-patic fibrosis serum makers ( HA, C IV) orγ-GT, which shows Pygo 2 expression can be taken as the clinical evaluation index of liver fibrosis in children with NAFLD .

Objective To evaluate global and segmental right ventricular ( RV ) systolic functions in patients with excessive volume or pressure load using real‐time three‐dimensional echocardiography ( RT‐3DE) . Methods Forty‐five patients with RV volume overload ,45 patients with RV pressure overload and 45 healthy subjects were underwent RT‐3DE . RV global and segmental ( inflow ,body ,outflow ) end‐diastolic volume (EDV) ,end‐systolic volume (ESV) ,stroke volume (SV) and ejection fraction (EF) were analyzed with TomTec software . The correlations between EF with the three‐dimensional method and two‐dimensional parameters including right ventricle systolic pressure( RVSP) were discussed . Results Global EDV and ESV increased significantly in both patient groups compared with controls ( all P < 0 .05) ,but there was no difference between two patient groups ( P >0 .05) .Compensated increase of SV was found in sixty percent of patients with volume overload but none with pressure overload ( P < 0 .05) . Global EF decreased significantly in both of patient groups (all P <0 .05) ,which was more significant patients with pressure overload ( P < 0 .05 ) . Different patterns of the regional dysfunction were found among the different RV segments . No correlation was found between RVSP and global or segmental EF in patients with pressure overload . Conclusions RT‐3DE could be used to assess global and segmental RV systolic function in patients with pressure and volume overload .