Female ; Humans ; Middle Aged ; Multiple System Atrophy ; diagnosis ; pathology

Objective:This article aimed to discusse the feasibility and effects of humanistic service using Kano model in outpatients .Methods:Using a self-designed Kano model outpatient humanistic service demand question-naire investigated clinic patients by using the Kano model analysis method , implementing humanistic service in the outpatient on the base of analyzing the starting point , and compare the satisfaction situation before and after the im-plementation .Results:There are service items including necessary quality , expected quality , attractive quality in Kano model analysis , 9, 8, 2 items respectively.After the implementation of humanistic service , patient's satisfac-tion increased significantly .Conclusion:The Kano model can be used in the outpatient services .The outpatient hu-manistic service could get the approvals from most outpatient patients .Outpatient humanistic service can improve the satisfaction of patients , so as to reduce medical disputes , alleviate conflicts between the doctors and patients , and improve the hospital popularity .

To evaluate the influence of phacoemulsification on corneal endothelium of senile cataract with lupus nephritis (LN).
●METHODS:This clinical trial involved 40 cataract patients with lupus nephritis (40 eyes), and 50 cases (50 eyes) without lupus nephritis. All of them underwent phacoemulsification+lOL implantation. The parameters of corneal endothelial cell including central corneal endothelium cell density ( CED ), average area of endothelial cell ( AVE) and coefficient of variation ( CV) were recorded by corneal endothelial microscope pre -operation and at one month after operation. The data were analyzed by SPSS 13. 0 statistical software.
● RESULTS: Both LN group and control group, the morphology of coneal endothelial was statistical significant differences between pre - operation and 1mo postoperation. The CED was lower, AVE and CV were higher ( P < 0. 05, respectively). A significant decrease in CED was seen in the LN group than did in the control group (P < 0. 05). Compared to control group,the post -operative AVE and CV in LN group was significantly increased (P<0. 05).
● CONCLUSlON: The corneal endothelial cell in lupus nephritis patients is more fragile. Safe and reliable operation should be selected for these patients.

AIM: To evaluate the efficacy of phacoemulsification and intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis.
●METHODS:Retrospective study. A total of 57 cases (57 eyes ) with complicated cataract with uveitis were involved in the study from Jan. 2015 to Dec. 2015. All cases underwent phacoemulsification and intraocular lens implantation surgery successfully. The postoperative reaction, effect, complications and so on were retrospectively analyzed after phacoemulsification and intraocular lens implantation surgery. The date of visual outcome was analyzed using Non - parametric Wilcoxon test.
●RESULTS: lris were bleed in 21 eyes ( 37%) , 4 eyes ( 7%) with posterior capsule rapture and posterior chamber intraocular lens was not implanted in 4 eyes ( 7%) . The uncorrected visual acuity ( UCVA ) was significantly increased after surgery. The UCVA of 8 eyes (14%) were 0. 1 or better before surgery, and the UCVA of 42 eyes (74%) were 0. 1 or better 3mo after surgery, the difference was statistically significant ( Z=23. 42, P<0. 001). The corneal edema (17 eyes, 30%), uveitis (2 eyes, 4%) and intraocular hypertension ( 1 eyes, 2%) were appeared in postoperative 1d. The corneal edema (3 eyes, 5%) was appeared in postoperative 1wk. The uveitis ( 1 eyes, 2%) was appeared in postoperative 1mo. The corneal edema (1 eyes, 2%), uveitis (2 eyes, 4%) , intraocular hypertension ( 1 eyes, 2%) and after-cataract ( 3 eyes, 5%) were appeared in postoperative 3mo.
● CONCLUSION: The phacoemulsification combined intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis has good effect and fewer complications.

Objective To evaluate the feasibility and principle of direct reduction and fixation through the pedicle of fractured vertebra in treatment of thoracolumbar burst fractures.Methods Between June 2001 and November 2005,24 cases of one level thoracolumbar burst fracture,16 males and eight females,were treated in our department.Their average age was 32.5 years old.The fractured vertebrae were as follows:T11 in two cases,T12 in nine cases,L1 in 11 cases and L2 in two cases.According to the ASIA(American Spinal Injury Association) neurological function grading system,there were one grade A,two grade B,five grade C,three grade D anti 13 grade E.The vertebral canal area blocked was rated as gradeⅠ(＜1/4)in three cases,gradeⅡ(1/4～1/2)in nine cases,gradeⅢ(1/2～3/4)in 10 cases and gradeⅣ(＞3/4)in two cases.The pedicle-screws were im- planted into the pedicles of the fractured vertebra and its adjacent ones.The connective rod was pre-bent according to the normal sagittal curvature of the fixation segment.After necessary decompression of the vertebral canal,the pedicle-screws stabilized the rod which was rotated to prop open upper and lower pedicle screws and push the burst vertebra so that the kyphosis and lateral dislocation were corrected.The graft bone was implanted between the transverse processes.Results On average,the height of fractured vertebra was restored from 48.3% of the normal value before operation to 93.6% after operation,the lateral dislocation from 17.1% to 0.6%,the Cobb's angle on the sagittal plane from 26.5?to 3.1?,and the Cobb's angle on the frontal plane from 9.5?to 0?.The area of vertebral canal was enlarged from 44.6% of the normal value to 92.1%.There were no complications.For in- complete neurological injuries,improvement of one to two grades was made in neurological functions.Conclusion Direct reduction and fixation through pedicles of fractured vertebrae is a safe and effective therapeutic option to treat the thoracolumbar burst fracture,for it can improve the stabilization and stress distribution.

ObjectiveTo investigate the epidemic situation of brucellosis in Datong city, and to provide scientific evidence for making appropriate prevention and control measures. MethodsSurveillance data of human brucellosis in 7 countris and 4 districts in Datong city between 2006 and 2009 were collected, throng the national network straight quote system in an infectious diseases. Excel database was established and all data were statistically analyzed. Incidence of brucellosis in local population was analyzed. The regional distribution, time distribution,occupation, age and sex distribution were analyzed. Epidemic characteristics and trend of brucellosis in Datong city were summarized. Results A total of 5195 cases of brucellosis patients in Datong were found between 2006 and 2009, the average incidence rate was 57.51/10 million. All counties had the disease, and the onset of the disease mainly in the spring and summer. Most cases were young males. Farmer case was 81.67％(4243/5195) of the total patients. ConclusionsFrom 2006 to 2009, epidemic characteristic of Datong human brucellosis ishigh-low-high(incidence). We suggests the Department concerned to strengthen the prevention and control of the disease in some counties, focusing on spreading of disease prevention and control knowledge among farmers and increase their self-protection awareness.

BackgroundPterygium is an ocular surface disease of abnormal cell proliferative kind and angiogenesis plays an important role in its development and recurrence.Several anti-angiogenic therapies have been used to treat pterygium,but there very few studtes for the in vivo observation of the microvessles in pterygium.ObjectiveThis study was to observe angiogenesis in pterygium with a high-resolution confocal microscope in vivo and to perform immunohistochemical study in vitro.MethodsA prospective case-controlled study was designed.Twenty eyes of 20 consecutive patients with primary pterygia and 20 age- and sex-matched patients with inner eye diseases and strabismus with normal conjunctiva were enrolled in this study.An in vivo confocal microscopy imaging system (Heidelberg Retina Tomograph Ⅱ Rostock Cornea Module) was used to collect microvascular pictures from the anterior part of pterygia and normal nasal conjunctiva of controls,and then immunochemistry was performed to examine the expression of CD31 in microvessel in vitro.The vascular density values were compared between these two groups.The correlation of vascular density values between in vivo Heidelberg Retina Tomograph and in vitro immunohistochemistry was calculated.Written informed consent was obtained from pationts before any examination and surgery.ResultsUnder the in vivo confocal microscope,the microvessel density was (8929±2993) μm/mm2 and (4202 ±692)μm/mm2,respectively,in pterygium and the normal conjunctiva group with a statistically significant difference between them (t =6.881,P＜0.01 ).Immunochemistry revealed that the expression of CD31 to measure vascular density was ( 21.00 ± 4.06/400 × field ) and ( 6.07 ± 1.75/400 × field ) in pterygium and the normal conjunctiva group,showing significant difference (t =12.312,P＜0.01 ).Positive correlations were found in the vascular density values between in vivo corneal laser confocal microscopy examination and in vitro immunochemistry examination in both the pterygium group and normal conjunctiva group (pterygium group:r=0.649,P＜0.01 ;normal conjunctiva group: r=0.572,P＜0.01 ) ConclusionsIn vivo confocal microscopy imaging is superior to in vitro immunochemistry in evaluating the microvessel of pterygium.The results of this study offer a new way index for further investigation of the biological behavior of pterygium and its mechanism.

Background Phlyctenular ophthalmia is a delayed hypersensitivity reaction to some microprotein and affected mainly by adolescent in high incidence.Objective This study was to investigate the microscopy findings of phlyctenular ophthalmia and evaluate the histological changes by laser scanning confocal microscope.Methods Twenty-nine eyes suffered from phlyctenular ophthalmia and twenty normal eyes were examined using laser scanning confocal microscope.The pictures were taken by a CCD camera.All the cases had initially chest X-ray,tuberculin test,bacterial and mycobacteria culture.Results Dendritic and inflammatory cells were increased and concentrated in conjunctiva,and epithelial cells were deformed and squamatizated.The capillaries engorged and the goblet cells were injured.The corneoscleral Vogt meshing of the phlyctenular keratitis was obscured and dendritic cells were intruded into the corneas.The corneal epithelium of phlyctenular keratitis was absent and the subepithelial nerve plexus were bended and fractured,and the dendritic and inflammatory cells were intruded.Scarring of corneal stroma was seen under the laser scanning confocal microscope.Conclusions Laser scanning confocal microscopy is valuable for basic research and clinical diagnosis of phlyctenular ophthalmia.

Objective To evaluate thri-operators and the blood-oxygen functional image technology in di-agnosing breast cancer. Methods One hundred and forty-six patients were admitted to hospital for operation due to one hundred and fifty-three suspicious lesions detected in their breasts. These lesions were detected by physical examination, thri-operators and the blood-oxygen functional image, mammography uhrasonography. The sensitivity and specificity of each diagnostic method were obtained and the radiolagie-pathologic correlation was meanwhile calculated. Results Sixty one(41.8%)breast lesions were diagnosed as malignancy. The sensitivity, specificity, accuracy,positive prognostic value and negative prognostic value of ultras onography were 80. 33% ,89. 41%,85.61% ,84.48% and 86.36%. Such data of mammography were 57.89% ,80. 36% ,69.03% ,75.00% and 65. 22%. And those of thri-operators and the blood-oxygen functional image technology were 91.80% ,83.53%, 86.99% ,80.00% and 94.67%. Conclusions Thri-operators and the blood-oxygen functional image technology is superior to uhrasonography and mammography in diagnosing breast lesions with its sensitivity accuracy and neg-ative prognostic value, while specificity and positive prognostic value were between them, have greater value in screeninging and the diagnosing breast cancer.

Objective To investigate the protective effect and possible mechanism of adiponectin (ADPN) and its receptors in diabetic nephropathy (DN). Methods A total of 64 Sprague-Dawley female rats were equally divided into diabetes mellitus (DM) group with streptozotocin(STZ) 60 mg/kg injection, and normal control (NC) group with the same dose of citric acid buffer randomly. At the end of 2, 6, 10 and 12 weeks, weight, fast blood glucose, 24-hour urinary albumin excretion, serum creatinine and serum fast blood insulin were measured. The level of adiponectin in urine and serum was examined by ELISA. The pathological change of kidney tissue was studied by periodic acid-Schiff's staining (PAS) and the expression of adiponectin receptor 1 (adipoR1), adiponectin receptor 2 (adipoR2) was determined by immunohistochemistry.The NRK-52E cells were cultured with 5 mmol/L glucose (control group), 30 mmol/L glucose (high glucose group), 30 mmol/L glucose+different concentrations of adiponectin (1 mg/L, 5 mg/L, 10 mg/L, ADPN groups), respectively. The mRNA expression of monocyte chemoattractant protein 1 (MCP-1) was measured by RT-PCR after 12 h. Results (1)Both in urine and serum, the levels of ADPN in DM group were higher than that in NC group after 6 weeks (P＜0.01) and increased gradually during the whole experiment. (2)Compared with NC group, the expressions of AdipoR1 and AdipoR2 in kidney tissues were elevated gradually in DM group. There was a significant positive correlation of ADPN with AdipoR1 and AdipoR2 in DM group(r=0.666, P＜0.01;r= 0.684, P＜0.01). (3)The expression of MCP-1 increased in high glucose group, but decreased in 1 mg/L, 5 mg/L, 10 mg/L adiponectin group. Conclusions The level of ADPN in urine and serum is positively correlated with its receptors and elevates with the process of diabetic kidney disease. High level of serum adiponectin plays a protective role through the direct action of AdipoR and the alleviation of MCP-1 expression in renal tubules.