Femtosecond laser-assisted cataract surgery(FLACS)has been used for more than 10 years, with its safety and precision well-verified. In recent years, FLACS has been gradually applied to patients with glaucoma and cataracts, especially those patients with primary angle closure glaucoma(PACG). The unique anatomical characteristics of PACG increase the difficulty of lens extraction and potential complications in conventional phacoemulsification surgery, highlighting the distinct advantages of FLACS in these patients. Recently, the application of FLACS combined with minimally invasive glaucoma surgery(MIGS)in patients with open angle glaucoma, and goniosynechialysis(GSL)in patients with angle-closure glaucoma, and even in patients with filtering blebs after anti-glaucoma surgery, has been reported. The indications for FLACS are increasingly expanding. FLACS can cause a transient intraoperative increase in intraocular pressure(IOP), and ocular parameters can have a certain impact on IOP. The long-term effects on IOP require further research. More attention should be paid to the impact of FLACS on visual function in glaucoma patients and the related complications that may arise. This article reviews the application of FLACS in different types of glaucoma, its effects on IOP and visual function, specific complications, and application prospects.

Esophageal squamous cell carcinoma(ESCC)is a major histological subtype of esopha-geal cancer with a poor prognosis.Although several serum metabolomic investigations have been reported,ESCC tumor-associated metabolic alterations and predictive biomarkers in sera have not been defined.Here,we enrolled 34 treatment-naive patients with ESCC and collected their pre-and post-esophagectomy sera together with the sera from 34 healthy volunteers for a metabo-lomic survey.Our comprehensive analysis identified ESCC tumor-associated metabolic alterations as represented by a panel of 12 serum metabolites.Notably,postoperative abrosia and parenteral nutrition substantially perturbed the serum metabolome.Furthermore,we performed an examina-tion using sera from carcinogen-induced mice at the dysplasia and ESCC stages and identified three ESCC tumor-associated metabolites conserved between mice and humans.Notably,among these metabolites,the level of pipecolic acid was observed to be progressively increased in mouse sera from dysplasia to cancerization,and it could be used to accurately discriminate between mice at the dysplasia stage and healthy control mice.Furthermore,this metabolite is essential for ESCC cells to restrain oxidative stress-induced DNA damage and cell proliferation arrest.Together,this study revealed a panel of 12 ESCC tumor-associated serum metabolites with potential for monitor-ing therapeutic efficacy and disease relapse,presented evidence for refining parenteral nutrition composition,and highlighted serum pipecolic acid as an attractive biomarker for predicting ESCC tumorigenesis.

Objective:To investigate the effect of lithium chloride (LiCl) on the gap junctional intercellular communication (GJIC) in human Tenon capsule fibroblasts (HTFs) and its underlying mechanism.Methods:The Tenon capsule tissue of a patient who underwent strabismus surgery in Dezhou People's Hospital in April 2019 was collected and cut into tissue blocks of dimensions 1 mm×1 mm×1 mm.Primary culture and subculture were carried out, and the 4th-generation HTFs were taken for experiment.HTFs were divided into the control group and LiCl treatment group and were cultured with cell medium without or with 80 mmol/L LiCl for another 48 hours according to grouping.The cell scratch and dye labeling technique were used to label the coupling index and evaluate the GJIC function.The expression and localization of Cx43 in HTFs were detected by immunofluorescence staining.The expression levels of Cx43 mRNA and protein were detected by real-time fluorescence quantitative PCR and Western blot, respectively.The study protocol was approved by an Ethics Committee of Dezhou People's Hospital (No.2019-023). Written informed consent was obtained from the subject.Results:The cultured spindle-shaped HTFs grew adhering to the wall showing radial monolayer or vortexlike, and the cytoplasm was vimentin positive.Results of dye tracer experiment of cell scratch showed that the cell coupling index of LiCl treatment group was 9.04±0.53, which was significantly higher than 4.94±0.39 of the control group ( t=-18.79, P<0.01). Immunofluorescence staining showed that the Cx43 fluorescence was dotted in the cell membrane between adjacent cells in the control group, and Cx43 staining was obviously enhanced in the LiCl treatment group.The results of real-time fluorescence quantitative PCR showed that with relative expression level of Cx43 mRNA in the control group set to 1, the relative expression level of Cx43 in the LiCl treatment group was significantly increased to 1.97±0.23, showing a statistical significance between them ( t=-14.426, P<0.01). Western blot showed that the relative expression level of Cx43 protein was 0.871±0.057 in the LiCl treatment group, which was significantly higher than 0.446±0.028 in the control group ( t=-11.682, P<0.01). Conclusions:LiCl can enhance the GJIC function between HTFs by upregulating the expression levels of Cx43 mRNA and protein, suggesting that the enhanced GJIC function by LiCl may be one of the mechanisms of its inhibition on HTFs proliferation.

OBJECTIVE: To assess the association of 5A/6A polymorphism in the promoter region of MMP3 gene with the stability of extracellular matrix of atherosclerotic plaque. METHODS: Clinical data of 776 consecutive patients undergoing percutaneous coronary intervention (PCI) was reviewed. MMP3 gene polymorphisms and serum level of MMP3 for the second admission were collected. The target gene fragment containing MMP3 promoter region was transfected into HepG2 vector cells. The influence of the polymorphism on the expression of the MMP3 gene was determined in vitro. RESULTS: Compared with the first admission data, the proportion of mutant MMP3 genotypes (5A/5A+5A/6A) was significantly higher in patients with acute myocardial infarction (AMI) compared with the control group (37.6% vs. 24.9%, P<0.01). 64.1% of the patients carrying the 5A allele had AMI, whereas only 50.11% of those carrying the 6A allele had AMI (P<0.01). The proportion of wild-type MMP3 genotype (6A/6A) was significantly higher in the stenotic group compared with the non-restenosis group (79.5% vs. 66.5%, P<0.01). Restenosis has occurred in 9.5% of patients harboring the 5A allele compared with 16.2% in those carrying the 6A allele (P<0.01). In addition, serum level of MMP3 in the restenosis group was significantly lower than that of the non-restenosis group (P<0.01). In vitro studies confirmed that the expression of pGL2-Basic/6A was significantly lower than that of pGL2-Basic/5A. CONCLUSION The 5A/6A polymorphism in the promoter region of the MMP3 gene may influence its transcriptional activity and impact on the degradation or push-up of extracellular matrix, resulting in a difference in the stability of atherosclerosis plaques, which in turn may induce different pathological processes in AMI or restenosis after stenting.
Case-Control Studies ; Extracellular Matrix ; Genetic Predisposition to Disease ; Genotype ; Humans ; Matrix Metalloproteinase 3 ; genetics ; Percutaneous Coronary Intervention ; Plaque, Atherosclerotic ; genetics ; Polymorphism, Genetic ; Promoter Regions, Genetic

Objective To investigate the effect of small dose methoxamine on parturient′s circulation stability and neonate during anesthesia of cesarean section .Methods Two hundreds and eighty-five cases of cesarean section under combined spinal epi-dural anesthesia in the hospital from January 2014 to June 2016 were selected and divided into 3 groups .The group A was intrave-nously injected by 1 mg of methoxamine hydrochloride instantly after anesthesia ,the group B by 2 mg ,while the group C was intra-venously injected by 2 mL of normal saline .The basic values at calmness after entering the operation room (T0 ) ,systolic blood pres-sure (SBP) and heart rate(HR) at horizontal position immediately after anesthesia(T1 ) ,at 1 min(T2 ) ,5 min(T3 ) after anesthesia , at 1 min(T4 ) before fetus delivery and at 5 min after fetus delivery (T5 ) were recorded ,and neonatal umbilical arterial blood pH value ,blood gas indicators and Apgar score at 1 min after delivery were also recorded .The parturient appearing the adverse reac-tions such as nausea and vomiting during operation were observed .Results HR at T2 in the group B and C was significantly in-creased ,then decreased significantly (P<0 .05) ,while which at T1 in the group A began to decrease and HR at the various time points of T2 -T4 were significantly lower than those in the group B and C ,moreover had no big fluctuation (P<0 .05);SBP at T2 in 3 groups was significantly decreased compared with that at T0 (P<0 .05) ,but SBP at the various time points of T2 -T4 in the group A were significantly higher than those in the group B and C (P<0 .05);umbilical vein blood pH ,blood gas indexes and Ap-gar score at 1 min after birth had no statistically significant differences between the group A and B (P>0 .05) ,but which in the group C were significantly lower than those in the group A and B (P<0 .05);the adverse reaction rate in the group A was 2 .11% , which was significantly lower than 9 .47% in the group B and 13 .68% in the group C (P<0 .05) .Conclusion Small dose of me-thoxamine can effectively maintain the parturient′s hemodynamic stability after combined spinal epidural anesthesia in cesarean sec-tion and has no adverse effect on neonate .

Objective To compare the application effects of different drug administration modes under continuous epidural anesthesia in elderly patients undergoing total hip replacement.Methods One hundred and twelve ASA Ⅱ-Ⅲelderly patients undergoing elective total hip replacement,55 males and 57 females,aged 75-91 years old,were randomly divided into the group A and B,56 cases in each group.After continuous epidural puncture success at L2-L3,the test dose of 2 ％ lidocaine 3 mL was injected,according the anesthesia plane,additional 2 ％ lidocaine 3-5 mL was injected,the group A adjusted the anesthesia plane to T10,after fixation,epidural continuous infusionof 2 ％ lidocaine 3 5 mL/h was performed according to the patient's condition;the group B adjusted the anesthesia plane to T10,after fixation,according to patient's condition epidural injection of 2 ％ lidocaine 3-5 mL/h was injected by several times.The two groups were given vasoactive drugs dopamine when necessary during operation.Mean arterial pressure(MAP),heart rate (HR) and pulse oxygen saturation (SPO2) at entering the operation room,30 min after medication injection,skin incision,postoperative 1 h and end of operation were recorded in the two groups.The anesthesia plane,anesthetic drug dosage,anesthesia effect and fotal dosage of dopamine were recorded in the two groups.Results Blood pressure after epidural drug administration in the two groups were significantly reduced,while the blood pressure after intraoperatively administrating additional drug in the group B was significantly decreased compared with the group A(P＜0.05).The anesthesia plane in the group A was more stable than that in the group B (P＜0.01),moreover the dosage of anesthetic drug was decreased significantly (P＜0.05).The intraoperative total amount of dopamine in the group A was obviously less than that in the group B (P＜0.05).Conclusion Micropump continuous drug administration during continuous epidural anaesthesia has little influence on the patient's hemodynamics than discontinuous single drug administration.In the condition without affecting the anesthesia effect,the anesthesia plane is more stable,the anesthesia drug dose can be significantly decreased,which is conducive to maintain the circulation stable and increase perioperative safety.

Background and purpose:Traditional Chinese medicine with notable effect and little adverse reaction is increasingly concerned about the medical profession because of its great potential and advantage in treating pancreatic carcinoma. In this experiment, we studied the effects of oridonin on apoptosis and cytoskeletal protein F-actin in human pancreatic carcinoma SW1990 cells. Methods:SW1990 cells in culture medium were treated with different concentrations of oridonin. The inhibitory rate of the cells was measured by MTT assay. Morphology of cell apoptosis was observed by DAPI stain and cell apoptotic rate was detected by lfow cytometry (FCM). The morphological changes of F-actin were observed by laser confocal microscopy. Results:The growth of human pancreatic carcinoma SW1990 cells was signiifcantly inhibited by oridonin. Apoptosis morphological changes including condensation of chromatin and nuclear fragmentation were observed clearly by DAPI stain. The early apoptotic rate of SW1990 cells treated with 25, 50μmol/L oridonin was signiifcantly higher than that of the control group (3.78±0.46, 9.51±0.63 vs 0.73±0.06, P<0.05), and the late apoptotic rate and cell necrosis rate were also signiifcantly higher than that of the control group (14.40±1.78, 20.53±2.54 vs 4.16±0.31, P<0.05). F-actin was showed from polymerization to depolymerization after oridonin treatment. Conclusion:Oridonin can obviously inhibit the proliferation and induce apoptosis of SW1990 cells. The mechanisms may involve the depolymerization of F-actin after treatment with oridonin.

Objective To analyse the 24 h ambulatory blood pressure monitoring(ABPM)character-istics and effect of health education in children with orthostatic hypertension (OHT)retrospectively.Methods A total of 19 children[1 1 males and 8 females with mean age of (1 1.26 ±2.16)years]who were outpa-tients or had been hospitalized in the Second Xiangya Hospital of Central South University due to unexplained syncope,presyncope,and finally diagnosed as OHT after head up tilt test(HUTT).HUTT and ABPM were reexamined at 12 ~190(47 ±48 )days after receiving health education (including psychological guidance, avoiding sudden changes in posture,increasing the amount of water,avoiding syncope inducement,etc). Results (1 )ABPM parameters:there were no significant differences of ABPM parameters before and after health education respectively(P ﹥0.05,respectively).(2)After the health education,HUTT 3 min diastolic pressure[(71.89 ±1.60)mmHg vs.(76.47 ±8.49)mmHg,1 mmHg =0.133 kPa,t =2.785,P ﹤0.05]and diastolic blood pressure change[(7.37 ±4.98)mmHg vs.(12.42 ±3.27)mmHg,t =3.560,P ﹤0.05]de-creased than those before health education.(3 )Blood pressure pattern changes:after the health education,“dipper blood pressure”increased and “non-dipper blood pressure”decreased[42.1 %(8 /19)vs.31.6%(6 /19)and 57.9%(1 1 /19)vs.68.4%(13 /19),χ2 =0.452,P ﹥0.05,respectively].(4)OHT cure rate:after health education,to review the HUTT,within 3 minutes in HUTT,blood pressure changes of 14 cases were normal range.The cure rate was 73.7%.Conclusion OHT children's blood type is given priority to with “non-dipper blood pressure”,and the ratio of“dipper blood pressure”increase and the HUTT 3 min di-astolic pressure and diastolic blood pressure change decrease after health education.It suggests that the health education of OHT children has a certain clinical effect.

Objective To establish thyrotropin( TSH) and thyroid hormones reference ranges during the neonatal period for the healthy term newborns in Suqian. Methods Blood samples from a heel-prick were collected from 500 healthy newborns 72 hours after birth to determine the level of TSH. 200 healthy newborns were chosen to determine the levels of serum TSH and thyroid hormones on the 14th day of life, and then compared with the results from 120 healthy adults. Results The reference range of TSH at 72 hours after birth was 0. 46-6. 59 mIU/ L. The reference ranges of TT3 , TT4 , TSH, FT3 , FT4 on the 14th day of life were 1. 10-2. 62 nmol/ L, 81. 10-158. 28 nmol/ L, 0. 83-6. 39 mIU/ L, 3. 76-6. 66 pmol/ L, and 10. 67-22. 27 pmol/ L, respectively. There was no significant difference in the interval of TSH between newborns and adluts, whereas there were significant difference in the intervals of TT3 , TT4 , FT3 , and FT4 between the two groups. Conclusions The establishment of TSH and thyroid hormone reference ranges during the neonatal period for the healthy term newborns could improve our understanding of the thyroid function during the neonatal period for the healthy term newborns, and our data suggests lowing the initiatory screening cut-off point of congential hypothyroidism.

Objective To investigate the relationship between matrix metalloproteinase-3 (MMP-3) gene promoter polymorphisms 5A/6A and the restenosis after percutaneous coronary intervention (PCI). Methods A total of 437 patients with PCI were selected in this study. Patients were divided into mutant genotype group (5A/5A+5A/6A, n=136) and wild genotype group (6A/6A, n=301) according to MMP-3 polymorphism. The angiography and clinic data were collected before and after coronary angiography in two groups of patients. The serum level MMP-3 and genotype analysis were compared be-tween two groups. Results There was no significant difference in the restenosis rate between two groups (42.2%vs 33.1%, P>0.05). The restenosis degree was significantly higher in wild genotype group than that in mutant genotype group (56.28%± 11.10%vs 36.00%±10.17%, P＜0.01). There was no significant difference in the serum level of MMP-3 between two groups (13.38μg/L ± 3.00μg/L vs 12.33μg/L ± 2.96μg/L, P>0.05). There was a higher restenosis rate in patients carrying 6A al-lele than that of patients carrying 5A allele (P＜0.05). Carrying wild genotypes are risk factors for restenosis after PCI. Con-clusion Patients carrying 6A allele have significantly higher risk of resteonsis than patients carrying 5A allele.