Background Cataract phacoemulsification combined with intraocular lens (IOL) implantation is a primary treatment for cataract.However,tear film stability and ocular surface structure are affected after surgery,especially some cataract patients with diabetes.Researches determined that tear film dysfunction is an important causative factor of dry eye.Objective This study was to investigate the change of tear film after phacoemulsification in cataract patient with diabetes.Methods A non-randomized cases-controlled study was designed.Thirty-six cataract patients with diabetes (54 eyes)and matched 32 patients (40 eyes)with age-related cataract were included in this study in Tianjin First Center Hospital from October,2010 to May,2011.Phacoemulsification and IOL implantation was performed on the all patients with the same topical eyedrops in both groups.Dry eye-related symptom was surveyed and scored by questionnaire,and tear film break-up time (BUT),Schirmer Ⅰ test(S Ⅰ t)and corneal fluorescein(FL) were examined 3 days before operation and 1 day,1 week,1month,3 months after operation.Written informed consent was obtained from each patient before entering this trial.Results The percentage with preoperative symptoms of dry eye was 36.2％ and postoperative dry eye symptoms accounted for 75.8％.Significant differences were seen in dry eye symptom score,FL score,BUT value and S Ⅰ t value between the diabetic cataract group and only cataract group as well as among 4 time points(dry eye symptom score:Fgroup =139.347,P =0.000 ; Ftime =342.741,P =0.000 ; FL score: Fgroup =14.073,P =0.000 ; Ftime =332.697,P =0.000 ; BUT value: Fgroup =28.198,P =0.000 ; Ftime =868.364,P =0.000 ; S Ⅰ t value: Fgroup =2.848,P =0.095 ; Ftime =564.017,P=0.000).FL scores of 2 groups were significantly higher in postoperation than those in preoperation (P＜0.05),and those of diabetic cataract group were significantly higher than only cataract group(P＜0.05),but no significant difference was found between postoperation 3 months and preoperation (P＞0.05).BUT was shorter in postoperation than that in preoperation in the diabetic cataract group(P＜0.05).S Ⅰ t values in postoperative 1 day and 1 week were significantly lower than in preoperation in both groups(P＜0.05).However,S Ⅰ t values returned to normal from 1 month through 3 months in both groups(P＞0.05).Conclusions Tear film dysfunction occurs after operationin cataract patient with type 2 diabetes.It is thought that cataract patient with diabetes is susceptible population of dry eye.Dry eye appears more early and severer in diabetes patients after phacoemulsification combined with IOL implantation.

BackgroundGlaucoma associates with apoptosis of retinal ganglion cells ( RGCs).Research showed that ciliary neurotrophic factor (CNTF) can repair optic nerve trauma,but it has not reported whether CNTF has a protective effect on glaucomatous optic neuropathy.ObjectiveThis experimental study was to explore the protective effect of CNTF on RGCs in rat eyes with acute ocular hypertension.MethodsOcular acute hypertension models were induced in bilateral eyes of 24 clean Wistar rats by forced perfusion of a balanced salt solution into the anterior chamber.Two days before molding,0.5 μg recombinant human CNTF (5 μl) was injected intravitreously in the left eyes,and 5 mmol/L sodium phosphate solution (5 μl) was injected in the same way as the control group.Three other Wistar rats were used as the normal control group.The animals were sacrificed by excessive anesthesia and the retinal sections were prepared 1,3,7,14 days after molding.The morphology of the retina was examined and RGCs counting was performed by hematoxylin & eosin staining and observed under a light microscope.The expression of glutamic acid in RGCs was assessed by immunochemistry.ResultsRegular retinal structure with clearly defined cell layers were observed in normal control rats.Changes in vacuoles in RGCs were seen in the model control group.The number of degenerative RGCs decreased in the CNTF group.Compared with the model control group,number of normal RGCs increased from 1 day to 14 days after molding with a significant difference between the two groups (all P=0.000).Immunochemistry assay showed that the numbers of positive cells for glutamic acid were 5.50±1.04 and 6.00±1.41 for the average of 3 fields at 3 days or 7 days in the CNTF group,and those in the model control group were 9.00±2.91 and 10.83 ± 1.94,respectively,showing significant differences between them ( all P =0.000 ).However,no comparable differences were found in the numbers of positive cells for glutamic acid at 1 day and 14 days between the two groups( P=0.578,0.180).ConclusionsCNTF down-regulates the expression of glutamic acid in RGCs and offers neuroprotection for RGCs in an acute glaucoma rat model.

OBJECTIVETo investigate how transient low dose of hydroperoxide pretreatment prevents cardiac ischemia/reperfusion injury.

METHODSSD rats were divided into 4 groups: sham operation (Sham), standard ischemia/reperfusion (I/R), ischemic preconditioning (IPC) and IR preceded by low H2O2 treatment. Cardiac function and injury parameter were compared among groups.

RESULTSIPC protected reperfusion injury and improved cardiac function. Low H2O2 treatment played a role in cardioprotection similar to IPC. Low H2O2 was indeed generated in the early phase of simulated ischemia and attenuated cytochrome c release induced by high Ca2+ in isolated mitochondria.

CONCLUSIONLow H2O2 plays a critical role in cardioprotection probably by inhibiting mitochondrial permeability transition.

Animals ; Hydrogen Peroxide ; administration & dosage ; Ischemic Preconditioning ; methods ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control

Objective To observe the clinical efficacy of acupuncture plus hyperbaric oxygen in treating depression after cerebral stroke.Method A total of 120 patients with depression after cerebral stroke were randomized into a treatment group of 60 cases and a control group of 60 cases. The treatment group was intervened by acupuncture plus hyperbaric oxygen, while the control group was intervened by Fluoxetine. Before the treatment, and respectively after 14-d and 28-d treatments, the patients were evaluated by Hamilton Depression Scale (HAMD) and National Institute of Health Stroke Scale (NIHSS), and the therapeutic efficacies were compared between the two groups. Result The treatment group was significantly superior to the control group in comparing therapeutic efficacy (P<0.01). After 1 course of treatment, the HAMD and NIHSS scores dropped significantly in the treatment group (P<0.01); the scores in the control group showed a declining tendency but without statistical significances (P>0.05). After 2 treatment courses, the HAMD and NIHSS scores were significantly different from those before the treatment in both groups (P<0.01), and the differences were more significant in the treatment group (P<0.01).Conclusion Acupuncture plus hyperbaric oxygen is effective in treating depression after cerebral stroke, and it can obviously improve the neural function.

Adult ; China ; Diagnostic Errors ; Diphtheria ; diagnosis ; Female ; Humans

Objective:This paper summarizes the practical problems encountered in the implementation of the tuition-free medical students' policyin rural areas of Sichuan Province, and provides a reference for the implementation of this policy across the province. Methods :Semi-structured interviews were conducted with the principals of the orientation management policies of the health administrative departments and county level and primary health care in-stitutionsin Sichuan, and the focus group interviews were used to understand the dynamics of directed students. Results :The survey results showed that there were limited channels for students to understand the policy ; students' barren understanding of the work of grass-roots doctors ; credit and integrity files played a relatively low role in retaining medical talent students;the willingness of orientation students is higher, but there is a contradiction between applying for graduate students and retaining grassroots in rural areas ; and the relevant departments lacked a rational and efficient management mode for students. Conclusions :In order to ameliorate the construction of rural health human resources,policy administrators should place their emphasis on cultivating the sense of honor and responsibility in the rural-oriented tuition-free medical students'policy, improve the reward and punishment mechanism in policies, optimize the management and assessment process, and promote the orientation of the work among the various policy-participating departments in a more harmonious and orderly manner.

OBJECTIVETo investigate the application of titanium mesh and free forearm flap for reconstruction of maxillary defect resulted from tumor resection.

METHODSFrom 2004 to 2008, 19 cases with maxillary tumor underwent tumor resection. The defects were reconstructed immediately with titanium mesh for bony defects and free forearm flap for oral mucosa defects.

RESULTS16 cases achieved satisfactory functional and cosmetic results. The speech assessment was good without oronasal reflux. The titanium mesh was exposed and infected in 3 cases. Then the meshes were taken out and the defects were covered with the forearm flap to close the oronasal fistula. The midface was slightly depressed with no functional morbidity.

CONCLUSIONSIt is simple and practical to reconstruct maxillary defect with titanium mesh and free forearm flap. Both the functional and cosmetic results are satisfactory.

Adolescent ; Adult ; Aged ; Female ; Forearm ; surgery ; Humans ; Male ; Maxillary Neoplasms ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Surgical Mesh ; Titanium ; Young Adult

Objective To study the relationship between the initial expression level of glucocorticoid receptor (GR) and the treatment outcome in children with acute lymphoblastic leukemia (ALL). And to evaluate if the initial expression level of GR could be the prognostic factor for children with ALL.Methods Anti-GR-antibody was used to measure the GR expression level in the bone marrow samples from 48 newly diagnosed children with ALL with flow cytometry. Also the GR expression levels in the patients at complete remission were mea-sured. Fifteen randonmized samples from ALL patients in continuous complete remission (CCR) were measured in this study. The GR expre-ssion levels of 30 blood samples from children in control group were monitored. Results The initial GR expression level had no association with the results after therapy. The GR expression level in CR and CCR had no statistic difference compared with that in control group.Conclusions It is not clear yet if the initial GR expression level could be the prognostic factor in children with ALL. Monitoring dynamic changes of the GR expression level in children with ALL seems to be of no remarkable significance.

Objectives To analyze the fatality and causes of death related to comprehensive prevention and care programs among HIV-infected patients in Dehong prefecture of Yunnan province,from 1989 to 2010. Methods Data on HIV/AIDS death cases in Dehong prefecture were extracted from the "Chinese National Comprehensive HIV/AIDS Prevention and Care Information System" and were analyzed. Results From 1989 to the end of 2010,a total of 13 493 HIV/AIDS cases registered as local residents or currently living m Dehong, had been reported. Among them, 8569 were reported as HIV cases with 2036 deaths and the other 4924 were reported as AIDS cases with 2251 deaths. A few of the cases had survived for 15-20 years. By the end of 2010, the number of deaths was higher than the number of survivors among HIV/AIDS cases reported before 2004, whereas the number of survivors was higher than the number of deaths among HIV/AIDS cases reported in 2004 and there after. During the twenty years' period,the proportion of reported HIV/AIDS cases died in the same year showed a secular trend of being low-highest-low, rising up to ＞ 10.0％ in 200 1, peaking at 18.9％in 2003 and then continuously going down to 5.8％ in 2010. The proportion of HIV/AIDS cases who survived at the beginning but died later in the year was going down since 2007. The proportion of HIV/ AIDS deaths died directly from AIDS was increasing whereas the proportion of HIV/AIDS deaths dying directly from overuse of drugs was decreasing in the recent years. Among HIV/AIDS deaths, the proportion of ever received CD4 + T-cell testing and the proportion of ever having received antiretroviral treatment were also increasing in the past years, reaching to 89.9％ and 25.5％ in 2010,respectively. Conclusion The case fatality of HIV/AIDS was decreasing in the past years in Dehong prefecture. More efforts were needed to scale up the CD4 + T-cell count testing and antiretroviral treatment in order to further reduce both morbidity and mortality among HIV/AIDS patients in Dehong prefecture. It is critical to improve surveillance program on HIV/AIDS deaths in the rural

Objective: To establish a survival prediction model based on the independent prognostic factors of long-term prognosis after laparoscopic liver resection(LLR) for intrahepatic cholangiocarcinoma(ICC). Methods: The clinical and pathological data of 351 consecutive patients with ICC who received radical LLR in 13 Chinese medical centers from August 2010 to May 2021 were collected retrospectively. There were 190 males and 161 females,aged(M(IQR)) 61(14)years(range:23 to 93 years). The total cohort was randomly divided into a training dataset(264 cases) and a validation dataset(87 cases). The patients were followed up by outpatient service or telephone,and the deadline for follow-up was October 2021. Based on the training dataset,the multivariate Cox proportional hazards regression model was used to screen the independent influencing factors of long-term prognosis to construct a Nomogram model. The Nomogram model's discrimination,calibration,and clinical benefit were evaluated through internal and external validation,and an assessment of the overall value of two groups was made through the use of a receiver operating characteristic(ROC) curve. Results: There was no significant difference in clinical and pathological characteristics and long-term survival results between the training and validation datasets(all P>0.05). The multivariate Cox analysis showed that CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis were independent prognostic factors for ICC patients after LLR(all P<0.05). The survival Nomogram was established based on the independent prognostic factors obtained from the above screening. The ROC curve showed that the area under the curve of 1, 3 and 5-year overall survival rates of patients in the training dataset were 0.794(95%CI:0.721 to 0.867),0.728(95%CI:0.618 to 0.839) and 0.799(95%CI:0.670 to 0.928),and those in the validation dataset were 0.787(95%CI:0.660 to 0.915),0.831(95%CI:0.678 to 0.983) and 0.810(95%CI:0.639 to 0.982). Internal and external validation proved that the model exhibited a certain discrimination,calibration,and clinical applicability. Conclusion: The survival Nomogram model based on the independent influencing factors of long-term prognosis after LLR for ICC(including CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis) exhibites a certain differentiation,calibration,and clinical practicability.
Bile Duct Neoplasms/surgery* ; Bile Ducts, Intrahepatic/pathology* ; CA-19-9 Antigen ; Cholangiocarcinoma/diagnosis* ; Female ; Humans ; Laparoscopy ; Lymphatic Metastasis ; Male ; Nomograms ; Prognosis ; Retrospective Studies