Objective To observe the occurrence and evolution of persistent submacular fluid (SMF) after scleral buckling surgery (SB) in rhegmatogenous retinal detachment,and then to study the related factors of persistent SMF and the effect of persistent SMF on visual outcome.Methods Ninety eyes of 89 patients with rhegmatogenous retinal detachment which had been performed SB were included in this study.Best corrected visual acuity (BCVA),intraocular pressure,slit-lamp microscopy,three mirror contact lens,indirect ophthalmoscopy and B-scan ultrasonography were measured for all patients.There were 21 eyes with atrophic holes while 42 eyes with horse-shoe tears,22 eyes with old retinal detachment while 68 new suffered eyes.Thirty-two eyes underwent scleral encircling surgery (SE) and 58 eyes underwent segmental scleral buckling surgery (SSB).The patients were divided into SMF group and non-SMF (NSMF) group according to the results of optical coherence tomography (OCT) at 1 month postoperatively.Thorough ophthalmologic examinations were performd at 1,3,6 and 12 months after surgery to the patients,further observations were continued to carry out unless the abnormality had resolved for at least 6 months.Results Patients who underwent SE (20 eyes,62.5 ％) had a higher incidence of persistent SMF at 1 month after surgery than those who underwent SSB (23 eyes,39.7 ％),the difference was significant (x2 =5.024,P＜ 0.05).Persistent SMF was more frequent in eyes with atrophic holes (66.7％) than that with horseshoe tears (38.1％),the difference was significant (x2 =4.582,P＜0.05).Persistent SMF was found in 72.7％ old retinal detachment eyes and in 39.7％ new suffered eyes,showed a striking differences (x2=7.264,P＜0.01).There was no significant difference in BCVA among SE and SSB groups at every time point (t=0.659,0.699,1.108,1.037,1.902; P＞0.05).The SMF group have a similar BCVA with NSMF group 1 and 3 months after surgery (t=1.812,1.957; P＞0.05),whereas the SMF group showed worse BCVA than NSMF group from since 6 months after surgery (t=2.324,2.147,2.184; P＜0.05).Conclusions Persistent SMF is more frequent after SE than SSB,the type of retinal breaks and old retinal detachment may be the potential influencing factors.Persistent SMF after SB may affect the final visual outcome.

Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment.Methods It was a retrospective case series study.A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study.All patients underwent vitrectomy operation.Additionally,they were given heavy water,membrane peeling,retinotomy or partial cutting,intraocular laser photocoagulation or frozen,gas-liquid exchange or direct oil exchange operation accordingly.Ninety-eight eyes with multiple holes,old retinal detachment,hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously.Intravitreal silicone oil was padded at the end of operation.Cutting,stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR.Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation.One week after SOR and during follow-up,the visual acuity,intraocular pressure (IOP),slit lamp microscope,and ophthalmoscope examination were examined with the same technique and methods as preoperation.The eyes were divide into two groups based on the attachment status of retina after SOR,which were reattached group (419 eyes) and redetached group (39 eyes) respectively.The following data were recorded.,the age of patients,ocular axial length,logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR,the number of retinal breaks,the duration of silicone oil filling,the duration of follow-up,and the related factors during vitrectomy operation and SOR.The relation of age,sex,high myopia,the size and location of holes,aphakic eye,proliferative vitreoretinopathy (PVR) C3 level and above,previous history of failed retinal detachment operation,360° preventive laser photocoagulation,assistant scleral buckling surgery,SOR via corneal puncture to RRD after SOR were analyzed.Odds ratio (OR) and its 95％ confidence interval (CI) were calculated for the age ＜40 years old and gender.High myopia,assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation.Results After SOR operation,the total average logMAR BCVA was 0.86 ± 0.63.The average logMAR BCVA was 0.82 ± 0.59 and 0.99 ± 0.70 respectively for the reattached and redetached groups,which was not statistically different (F=1.559,P＞0.05).The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes,respectively,accounted for 27.7 ％ and 56.4 ％,and the difference was statistically significant (x2=13.984,P＜0.01).Three eyes underwent vitrectomy with scleral buckling occured RRD,accounting for 3.1％; while 36 eyes underwent vitrectomy without scleral buckling occured RRD,accounting for 10.0％.The incidence of RRD between them was statistically significant (x2 =4.761,P＜0.05).The incidence of RRD was not retated to the PVR levels before the operation,previous history of failed retinal detachment operation,aphakic eye and preventive laser photocoagulation (OR=1.626,1.699,1.986,0.709; 95％ CI:0.836-3.162,0.832-3.658,0.921-4.279,0.268-1.875; P＞0.05).RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380,0.284; 95％CI:1.733-6.595,0.086-0.944; P＜0.05).The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95％CI:1.043-4.306; P＞0.05).The incidence of RRD after SOR was 8.5％; of which,35.9％ originated from new breaks and 69.2％ were related to new breaks,in contrast,only 5.1％ originated from PVR but 51.3％ were related to PVR.Conclusions High myopia is an independent prognostic risk factor of RRD after SOR.Combined scleral buckling surgery is a protective factor of RRD after SOR.To the well reattached eyes before SOR,the new breaks seems to be the main cause of RRD,wheras PVR was probably a secondary phenomenon.

Therapeutic strategies targeting tumor angiogenesis have been approved for cancer therapy. Vasculature normalization induced by anti-angiogenic drugs can restore abnormal tumor vessels, and improve the tumor microenvironment characterized by hypoxia, extracellular acidosis, and high interstitial lfuid pressure, improve the cancer treatment results by chemoradiotherapy and immunotherapy.

Objective To study the thrombolysis effect and safety of tirofiban combined with half dose reteplase in patients with ST segment elevation acute myocardial infarction .Methods 60 patients with ST segment elevation acute myocardial infarction in our hospital from January 2011 to March 2013 were selected as research object ,and they were divided into reteplase group (control group ,n=32) and tirofiban combined with reteplase group (observation group ,n=28) ,then the recanalization rate of infarct-relat-ed artery at different time and incidence of complications were compared .Results The recanalization rate of infarct-related artery of observation group at different time were all higher than those of control group (P<0 .05) ,while incidence of complications of two groups had no significant difference(P>0 .05) .Conclusion The thrombolysis effect of tirofiban combined with half dose reteplase in patients with ST segment elevation acute myocardial infarction is better ,and it does not increase the incidence of complications .

Objective To investigate the effects of electroacupuncture (EA) pretreatment on the expression of phosphorylated signal transducer and activator of transcription 3 (pSTAT3) in cortical neurons in a rat model of focal cerebral ischemia/reperfusion (I/R) injury.Methods Forty-five adult male Sprague-Dawley rats,weighing 280-320 g,were randomly divided into 3 groups (n =15 each):sham operation group,I/R group and EA pretreatment group.Focal cerebral ischemia was induced by middle cerebral artery occlusion for 120 min,followed by 24 h of reperfusion.EA of Baihui acupoint lasting 30 min was performed and then the model of focal cerebral I/R was established 24 h later in EA group.Neurological function was assessed and scored at 24 h of reperfusion.The rats were then sacrificed and brains removed for detection of the cerebral infarct volume and expression of pSTAT3 (Ser727) in cortical neurons in ischemic penumbra by immunofluorescence and Western blot.Results Compared with sham operation group,the neurological function score was decreased,the infarct volume was increased,and the expression of pSTAT3 (Ser727) was up-regulated in groups I/R and EA (P ＜ 0.05).Compared with I/R group,neurological function score was increased,the infarct volume was decreased,and the expression of pSTAT3 (Ser727) was up-regulated in group EA (P ＜ 0.05).Conclusion EA pretreatment reduces focal cerebral I/R injury through up-regulating pSTAT3 expression in cortical neurons in rats.

Objective To investigate the effect of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude.Methods 60 patients with esophageal cancer radical surgery was selected from March 2015 to March 2017 in our hospital and were divided into two groups according to the random number table,30 patients in each group.Patients in the control group were given with fentanyl and propofol intravenous anesthesia,and patients in the observation group were given sufentanil combined with propofol anesthesia.The occurrence of restlessness during the recovery of anesthesia in the two groups were observed,the spontaneous breathing recovery time,extubation time and postoperative Mini-mental State Examination (MMSE) score were recorded,and the indexes of hemodynamics and oxygen metabolism were measured at the time of before induction of anesthesia (T0),tracheal intubation (T1),skin incision (T2),thoracotomy (T3),free esophagus (T4),esophageal catheter removal time (T5).Results The spontaneous respiration recovery time and extubation time of the observation group were significantly shorter than those of the control group (P ＜ 0.05).The degree of restlessness in the observation group was weaker than that in the control group (P ＜ 0.05).Mean arterial pressure (MAP) in the control group at T2-T4 were significantly higher than those in T0 (P ＜ 0.05),but MAP and heart rate (HR) in the observation group at T1-T5 were significantly lower than those of T0 (P ＜ 0.05).Compared with T0 group,oxygen saturation (SpO2),oxygen saturation of mixed venose blood (SvO2) and oxygen delivery (DO2) at T1-T5 were significantly decreased (P ＜ 0.05),oxygen consumption (VO2) at T2-T4 was significantly increased (P ＜ 0.05),especially in the control group (P ＜ 0.05).The MMSE scores of the two groups were significantly lower than those before the operation (P ＜ 0.05),and the scores in observation group was significantly higher than the control group (P ＜ 0.05).Conclusions The intravenous anesthesia with sufentanil combined with propofol is more helpful in maintaining hemodynamic stability and oxygen metabolism balance than intravenous anesthesia with fentanyl combined with propofol and has little effect on postoperative anesthesia recovery and cognitive function.

Objective To evaluate the effect of sevoflurane-containing HTK solution on electro-physiological stability of rat donor heart during reperfusion. Methods Male Sprague-Dawley rats, weighing 280-320 g, aged 3 months, in which a Langendorff-perfused isolated rat donor heart model was estab-lished, were used in this study. Sixteen donor hearts were obtained and divided into 2 groups (n＝8 each) using a random number table method: control group (group C) and sevoflurane group (group S). HTK so-lution was used as preservation solution in group C. HTK solution containing 2. 5% sevoflurane was used as preservation solution in group S. Hearts were stored for 6 h in the corresponding preservation solution at 4℃ and then reperfused, and the perfusion temperature was gradually restored to 37 ℃ in two groups. The time of spontaneous recovery of heart beat and development of arrhythmia were recorded. Heart rate, monophasic action potential (MAP) duration at 50% and 90% repolarization (MAPD50, MAPD90), MAP amplitude and maximum velocity and development of early after-depolarization and delayed after-depolariza-tion were recorded at 30 and 45 min of reperfusion. Results Compared with group C, the time of sponta-neous recovery of heart beat was significantly shortened, the incidence of ventricular fibrillation and arrhyth- mia score were decreased, the ventricular fibrillation interval was shortened, and MAPD50and MAPD90of epicardium and endocardium were shortened at 30 and 45 min of reperfusion (P＜0. 05), and no significant change was found in hear rate, maximum velocity or MAP amplitude in group S (P＞0. 05). Early after-de-polarization and delayed after-depolarization were not found in two groups. Conclusion Sevoflurane-contai-ning HTK solution can maintain electrophysiological stability of rat donor heart during reperfusion and de-crease the occurrence of arrhythmia.

Objective To investigate the electrophysiological protective effect of HTK solution containing sevoflurane on rat cardiac transplantation. Methods Twenty-four male Sprague-Dawley rats were divided into the control group,sevoflurane group and Heptanol group. Rat hearts in 3 groups were stored in HTK solution,containing sevoflurane and sevoflurane+heptanol HTK solution for 6 h. Heart resuscitation time,the duration of arrhythmia and monophasic action potential(MAP)and heart rate(HR)at different time points were recorded.Monophasic action potential duration of repolarization at 50% and 90%(MAPD50 and MAPD90),monophasic action potential amplitude(MAPA)and maximal velocity(Vmax)were analyzed. Results The isolated rat hearts in each group can be successfully restored to the spontaneous heart beat. Compared with group C ,heart resuscitation time in group S and group H was significantly shortened,heart rate(HR)was significantly decreased at T1,MAPD50 and MAPD90 in heart intima and epicardium were shortened at T1 ~ T2,the incidence of ventricular fibrillation and reperfusion arrhythmia Scores were reduced,with the shorter duration of ventricular fibrillation(P<0.05). No significant difference was found in Vmax and MAPA among the three groups at each time point. Conclusion HTK solution containing sevoflurane and HTK solution containing heptanol had similar electrophysiological effects ,which could inhibit the prolonged monophasic action potential(MAP)and reduce arrhythmia. The electrophysiological protective effect of HTK solution containing sevoflurane may be associated with the inhibition of gap junction function.

ObjectiveTo investigated the effect of post-operative primary site radiotherapy on stage Ⅳ neuroblastoma.Methods From Jan 2003 to Dem 2010,47 newly diagnosed stage Ⅳ neuroblastoma treated in Sun Yet-sen university cancer center.The treatment protocol for these patients were induction chemotherapy 4- 12 cycles,followed by surgery if possible,then 4-6 cycles consolidation chemotherapy and/or primary site radiotherapy and maintenance immunotherapy.The median age was 4 years old,the median induction chemotherapy cycles was 5.37 patients received resection of the primary tumor (total resection and nearly gross resection).24 out of 37 received primary site radiotherapy.ResultsThe followup rate was 89％.34 cases were followed up more than 36 months.For patients with or without postoperative primary site radiotherapy,the local recurrence rate were 13％ ( 3/24 ) and 54％ ( 7/13 ),respectively ( P =0.016),the 3-year local control rate were 84％ and 47％,respectively ( χ2 =7.95,P =0.005 ).The 3-year overall survival rate were 56％ and 28％,respectively ( χ2 =5.44,P =0.020 ). There was no severe radiation side effect. Conclusions This study indicated that postoperative primary site after induction chemotherapy and surgery could reduce the local recurrence rate and possibly improve the overall survival rate of stage Ⅳ neuroblastoma.

Objective: To investigate the effect of gross total resection on the local control and survival of patients with stage IV neuroblastoma (NB) and analyze the extent of surgical resection of primary tumors that affects patient survival. Methods: A total of 96 patients with stage Ⅳ NB who were admitted to the Sun Yat-Sen University Cancer Center between January 2000 and December 2011 were analyzed. The patients were treated with combined-modality therapy, including chemotherapy, surgery, and/or radiotherapy. The patients were divided according to the extent of surgical resection of primary tumor into the following groups: group A, biopsy or tumor removal of less than 50% of the primary lesion; group B, incomplete resection of more than 50% but less than 90% of the lesion; group C, removal of more than 90% of the lesion; and group D, complete resection with or without macroscopic residual tumors. The survival rates of each group were analyzed. Results: The median age of the 96 patients was 4.4 years, ranging from 1.2-18.8 years. The overall 3-year progression-free survival (PFS) and overall survival (OS) of the total patients were 32.8% and 36.7%, respectively. A total of 24 cases were assigned in group A, 10 in group B, 23 in group C, and 39 in group D. Subgroup analysis revealed that the 3-year PFS rate was 17.5% for group A, 20.0% for group B, 45.1% for group C, and 40.5% for group D. The PFS rates were not statistically significant-ly different between groups A and B (P=0.352) and between groups C and D (P = 0.792). However, the OS was higher in groups C and D than that in groups A and B. The 3-year PFS rates were 42.2% and 17.8% for groups C and D (P<0.001), respectively. Conclu-sion: Resection extension of more than 90% of the primary tumor combined with chemotherapy and (or) radiation therapy can improve the survival of patients with stage Ⅳ NB. However, this treatment modality does not affect the treatment outcomes for minimal gross tu-mor residuals.