Purpose: To assess the feasibility of applying ultra-widefield fundus (UWF) images for macular staphyloma area (MSA) measurement and investigate the associated factors with MSA. Methods: This is a retrospective study. MSA was measured by UWF imaging. Central foveal thickness, subfoveal choroidal thickness, subfoveal scleral thickness were measured on spectral domain optical coherence tomography. Intraclass correlation coefficients of MSA measurement would be evaluated. Multiple linear regression analysis was used to analyze the associated factors with MSA. Results: In total, 135 eyes of 92 patients were enrolled. The mean age was 64.73 ± 10.84 years. Mean MSA on UWF image was 279.67 ± 71.70 mm2. Intraclass correlation coefficients of MSA measurement was 0.965 (95% confidence interval [CI], 0.946 to 0.977; p < 0.001). In the multiple linear regression analysis, after adjusting for subfoveal choroidal thickness, best-corrected visual acuity, central foveal thickness, and subfoveal scleral thickness, the factors independently related to MSA were axial length (β = 8.352; 95% CI, 3.306 to 13.398; p = 0.001), sex (β = -26.673; 95% CI, -51.759 to -1.586; p = 0.037), age (β = 1.184; 95% CI, 0.020 to 2.348; p = 0.046). Conclusions It is feasible to measure MSA on UWF image. Female, longer axial length, and older age may indicate larger MSA.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.

Objective To evaluate the effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section.Methods Four hundred parturients (ASA Ⅱ-Ⅱ) undergoing cesarean section were randomly allocated into 4 groups,including sufentanil group (group S,96 cases),sufentanil combined with flurbiprofen axetil group (group SK,99 cases),butorphanol group (group N,106 cases) and butorphanol combined with llurbiprofen axetil group (group NK,99 cases).All the parturients received the operation under epidural combined with spinal anesthesia,and received patient-controlled intravenous analgesia (PCIA) after cesarean section.Numerical rating scale (NRS) of postoperative rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and PCIA-related adverse events were recorded for 24 h after operation.Results All the parturients were finished this study.The age,body weight,gestational weeks and operative time in 4 groups had no significant difference (P ＞ 0.05).The NRS score of rest incisional pain was equivalent among the 4 groups (P ＞ 0.05).The NRS score of dynamic incisional pain after operative 13 h in group S was significantly lower than that in group N[(3.6 + 1.3) scores vs.(5.4 + 1.2) scores](P＜ 0.05).The NRS score of uterine contraction pain after operative 4,13 h in group N and group SK was lower than that in group S [(1.3 ± 1.0),(1.1 ± 0.9) scores vs.(2.5 ± 1.1) scores and (1.6 ± 1.0),(1.4 ± 0.9) scores vs.(2.9 ± 1.1) scores] (P ＜ 0.05).The RSS scores and incidence rate of dizziness were significantly higher in group N than those in group S (P ＜0.05).No abnormality of new-horn infant was recorded in 4 groups.Conclusion Sufentanil combined with nonsteroidal antiinflammatory drugs can perform effective and safe analgesia on postoperative incisional and uterine contraction pain after cesarean section.

Objective To compare the effect of perioperative intravenous injection of Analgecine on the analgesic efficacy and complications of patient-controlled intravenous analgesia ( PCIA ) of different doses of fentsnyl in postoperative lumhotomy patients.Methods 200 patients underweat hmbotomy in general anesthesia were randomly divided into four groups with fifty cases each.Fentanyl 1.0mg in group A,fentanyl 0.5mg in group B,fentanyl 1.0mg in group C,fentanyl 0.5mg in group D.The drugs in each group were diluted to 100ml and infused by pumps.Besides,the patients in group C and D were injected with analgecine 3.6u and 7.2u at the night before the operation,preoperation and postoperation respectively.The visual analog scale(VAS),times of PCA and incidence of side effects were recorded during the period of postoperative 24 hours.Results The VAS of group B at 2h after operation was (5.2 ± 1.9 ) points,which was significandy higher than that of group A,C and D( P ＜ 0.05 ),VAS became similar 4h later( P ＞0.05).The demanding times for supplemental bolus in group B were also significantly higher than that of A,C and D( P ＜ 0.05 ).The incidence of nausea,vomiting,itching,somnolence in group B and D were significantly less than those in group A and C( P ＜0.05 ).No respiratory depression or abnormal bleeding occurred in the four groups.Conclusion Perioperative intravenous injection of analgecine had a better effect on PCIA of fentanyl and could reduce fentanyl requirement and its side effects in lumbotomy patients.

BACKGROUND: Islet transplantation is an effective therapy for type I diabetic patients sensitive to insulin.OBJECTIVE: To investigate and evaluate the status and obstacles of islet transplantation in type I diabetes in China.METHODS: Published articles reported from January 1980 to December 2008 on Chinese Medical Current Contents database,the national funds from 2002 to 2008 in the database of National Natural Science Foundation of China on islet transplantation were searched to analyze the status of islet transplant research and clinical practice in China.RESULTS AND CONCLUSION: 340 articles were reported from 1980 to 2008 related to islet transplantation in China, including 165 (48.5%) basic research, 45 (13.2%) clinical research and 130 (38.2%) reviews. Most of researches were conducted in the developed regions in the east of China. The Edmonton protocol had a great impact on the islet transplant research in China, and many projects of islet transplant have been supported by the National Natural Science Foundation. However, there remains obstacles in this field, such as organ and capital shortage and incomplete organ donation system.

BACKGROUND: A better understanding of medical students' attitude towards living liver donation in China would be of importance significance in the development of organ transplantation. OBJECTIVE: To investigate the medical students' attitude toward living liver donation in China and to analyze the factors that affect such an attitude.METHODS: A random sample of 250 medical students was taken and stratified by grades with 50 students in each grade. The attitude was evaluated by a modified psychosocial questionnaire from Spain. The questionnaire was completed anonymously and was self-administered. A bivariate analysis including the Student's t test and the Chi-square test was performed using SPSS software. RESULTS AND CONCLUSION: The questionnaire completion rate was 97.2% (n=243) for the medical students. Among the respondents, only 13.2% (n=32) of them were in favor of unrelated living liver donation. Another 66.3% (n=161) were only in favor if the donation was for a relative. Of the rest, 6.6% (n=16) did not agree with living liver donation, and the remaining 14.0% (n=34) were undecided. The factors related to this attitude were the decision of donating the organs of a family member (P=0.002), attitude toward deceased donation (P=0.000), a willingness to receive a donated living liver organ if one were needed (P=0.000), attitude toward living kidney donation (P=0.000). The medical students have a favorable attitude toward living liver donation in China. The students' attitude toward other types of organ donation and the willingness to accept living donated liver influence their attitude toward living liver donation. There is a great lack of education about the organ donation and transplantation for the medical students in China and more education programs should be incorporated into their traditional curriculum.

Objective To investigate the effect of total hip arthroplasty in treatment of patients with ankylosing spondylitis and bilateral hip bony ankylosis. Methods 43 patients with ankylosing spondylitis and bilateral hip bony ankylosis were randomly divided into observation group (23 cases) and control group (20 cases) in accordance with the principle of informed consent, individually treated by total hip arthroplasty and conservative treatment, the effect of two groups were compared and analyzed. Results In the observation group, the postoperative Harris hip score and the VAS pain score of patients were significantly better than the control group,the differences were all statistically significant between two groups( all P ＜ 0.05 ). Excellent rate of the two groups were 91.3% and 60.0% respectively, and the difference was statistically significant ( x2 = 4.328, P ＜ 0.05 ). Conclusion Total hip arthroplasty in treatment of patients with ankylosing spondylitis and bilateral hip bony ankylosis has better clinical effect, and could improve the quality of life of patients, so it was worthy of clinical application.

Objective The purpose of this study was to determine how to preserve the remaining pancreatic body and tail in the pancreatectomy. Methods In seven cases of pancreatectomy, three of them were the rupture of pancreatojejunal anastomosis, and four of them were the pancreatectomy for tumor in the pancreatic neck or body. During operations, a bridge internal drainages was used to drain the pancreatic juice into the adjacent jejunum. After the operations, the supportive treatment, continuous irrigation of peritoneal cavity and pancreatic enzyme inhibition were used. Results In all seven patients, the remaining pancreatic body and tail were successfully preserved. The endocrine functions of these patients recovered to nearly normal level and patients were discharged. Conclusions In preserving the remaining pancreatic body or tail, the bridge internal drainage has its advantage of convenience. It effectively preserves the exocrine of pancreas as well as its endocrine

Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.