AIM: To investigate the effect of intense pulsed light(IPL)combined with meibomian gland massage in patients with meibomian gland dysfunction(MGD)related dry eye.METHODS: Retrospectively selected 300 cases(300 right eyes)that diagnosed as MGD-related dry eye and treated in our hospital from October 2021 to October 2023, and they were divided into two groups according to the treatment modalities: 150 cases(150 eyes)in the control group were treated with meibomian gland massage, and 150 cases(150 eyes)in the observation group were treated with combined IPL. The efficacy of the two groups was compared, as well as the changes in tear film stability indexes [tear film break-up time(BUT), Schirmer I test(SIT)], ocular surface disease index(OSDI)scores, tear film lipid layer thickness(LLT), mean objective scattering index(OSI), and the levels of inflammatory factors in the tear fluid [interleukin-10(IL-10)and IL-6].RESULTS: There was a difference in efficacy between the two groups of patients after treatment(88% vs 74%, P=0.002). At 8 wk after treatment, OSDI score, OSI, and tear IL-6 levels decreased, while BUT, SIt, LLT, and tear IL-10 levels increased in the two groups, and the observation group was better than the control group(all P<0.05).CONCLUSION: IPL combined with meibomian gland massage for the treatment of dry eye patients with MGD is therapeutically effective, improving corneal stability and LLT, and reducing levels of OSI and inflammatory factors.

OBJECTIVETo explore the role of sphingomyedlin phosphodiesterase 1 (SMPD1) gene mutations in the pathogenesis of Parkinson's disease (PD).

METHODSFor 110 Chinese patients with PD, all exons of the SMPD1 gene were sequenced, and the results were compared with reference sequence from GenBank to identify possible mutations.

RESULTSA novel heterozygous mutation Ex2:c.677C>A/p.P226Q (likely pathogenic) was identified in a patient, which resulted in substitution of Glutamic acid by Proline at position 226. In addition, two known single nucleotide polymorphisms (SNPs) Ex1:c.107T>C/p.V36A (benign) and Ex6:c.1522G>A/p.G508R (benign), and three previously reported SMPD1 mutations Ex2:c.T371T>G/p.L124R (uncertain significance), Ex2:c.636T>C/P.(=)(benign) and Ex6:c.1598C>T/p.P533L (uncertain significance) were identified. The novel p.P226Q mutation and p.P533L mutation were predicted to have a possibly damaging effect on the structure and function of SMPD1 protein, which in turn may lead to PD.

CONCLUSIONThe mutation rate of the SMPD1 gene was 3.64% among Chinese PD patients. Genetic variants of SMPD1 may increase the risk of PD.

Objective To investigate the influence of age on perioperative clinical parameters, tumor resection effects and complications of patients with early stage gastric cancer for single lesion treated by ESD.Methods 60 patients with early stage gastric cancer for single lesion treated by ESD were chosen from January 2013 to July 2014 and divided into 2 groups including A group (35 patients) with < 60 years old and B group (25 patients) with ≥ 60 years old; and the operation time, intraoperative blood loss, hospital staying time, tumor curative resection and completed rate, the recurrence rate with follow-up and complications incidence of 2 groups were compared.Results All the patients were successfully performed the operation and no bleeding cases. There was no significant difference in the operation time, intraoperative blood loss, hospital staying time between 2 groups (P < 0.05). There was no significant difference in the tumor curative resection and completed rate between the 2 groups (P < 0.05). There was no significant difference in the recurrence rate with follow-up between 2 groups (P < 0.05). There was no signiifcant difference in the complications incidence between 2 groups (P < 0.05).Conclusion ESD is safe and feasible in the treatment of elderly patients with early stage gastric cancer for single lesion, and it is equivalent to short- and long-term efifcacy in non-elderly patients and not increase the operation time, the trauma degree and complications risk.

Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.

Objective To introduce the clinical application of a extensive revense peroneal artery flap in repairing big soft tissue defect in foot, especially in repairing a big defect in distal foot and the exposure of one or more metatarsophalangeal joint. Methods The skin flaps were used in 11 cases to repair the big soft tissue defect in foot, including the distal part of foot. The flap upper boundary may surpass the capitulum fibulae; The lower boundary may reach the back line between external malleolus and internal malleolus; Lat-eral boundary could overrun anterior margin of fibula about 2 cm; Inboard boundary could get to medial mar-gin of gastrocnemius muscle. In attention: the two branch vessels from peroneal vessel in the site of 11-13 cm and of 5-7 cm above the outer anker would be included in the flap. Results Ten of 11 skin flaps survived satisfactory. A small, marginal portion of one flap in one case presented necrosis. Conclusion The reverse peroneal artery flap is easy to elevate and safety, which is an ideal flap for a huge soft tissue defect in foot, especial in the distal part of foot.

BACKGROUND:Vascular endothelial growth factors (VEGF) can promote the division of endothelial cells and accelerate the growth of newborn vessels, whereas the expression and distribution of VEGF receptors (VEGFR) in spinal cord should be observed.OBJECTIVE: To observe the expression and distribution of VEGFR-1 and VEGFR-2 in rat spinal cord.DESIGN: A randomized controlled observation.SETTING: Department of Orthopaedic Surgery, the First Affiliated Hospital of Dalian Medical University; Department of Hand Surgery, Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: Ten adult male Wistar rats of clean degree, weighing 180-200 g, were provided by the animal experimental center of Tongji Medical College, Huazhong University of Science and Technology. Immunohistochemical primary antibody was purchased from Santa Cruz Company; the second and third antibodies from Beijing Zhongshan Biotechnology Co., Ltd. Reverse transcription-polymerase chain reaction (RT-PCR) kit was the product of Promega,Trizol reagents were purchased from Invitrogen Company, and the VEGFR-1 and VEGFR-2 primers were designed by Beijing Aoke Company.METHODS: The experiment was carried out in the laboratory of Department of Hand Surgery of Wuhan Union Hospital from March to June in 2004. ① Detection of VEGFR expression in spinal cord anterior horn: The rats were anesthetized by 100 g/L chloral hydrate, spinal cord of lumbar 4-6 (L4-6) was fixed in fixation solution at 4 ℃ for overnight, then routine dehydration, hyalinization and paraffin embedding were performed, and serial sections of about 5 μm were prepared for observing the VEGFR expressions using immuniohistochemical staining. ② Detection of VEGFR mRNA expression in spinal cord: Five rats were selected, L4-6 spinal cord (50 mg) was removed and centrifugated, then the content of total RNA was determined with ultraviolet spectrophotometer. The synthetized cDNA was amplified with PCR, and the PCR products (10 μL) were treated with 20 g/L agarose gel electrophoresis, and stained with 0.1 mg/L ethidium bromide, the results were observed and recorded under ultraviolet lamp and photographed. The products were scanned and quantified with gel imaging analytical system to record the gray value of each band, the gray value of β-actin band was taken as 1,and those of the other objective fragments were compared with it to record the gray value ratio and analyze the expressions of the objective fragments.MAIN OUTCOMEMEASURES: ① Expression and distribution of VEGFR-1 and VEGFR-2 in rat spinal cord anterior horn;② Results of VEGFR mRNA expression in spinal cord.RESULTS: ① Both VEGFR-1 and VEGFR-2 were expressed in the microvessels of normal rat spinal cord tissue.Besides, VEGFR-2 mainly expressed in motor neurons, glial cells and the nerve fibers in surrounding white matter. ②The results of gel imaging analytical system showed that the VEGFR-2 content in normal spinal cord was obviously higher than VEGFR-1 (0.874±0.222, 0.486±0.181, P ＜ 0.05).CONCLUSION: VEGF promote the formation of microvessels through the combined effects of VEGFR-1 and VEGFR-2,and it plays the neurotrophic and neuroprotective role through VEGFR-2.

This study is to investigate the effect of local phVEGF(165) injection on sciatic nerve regeneration in the rats and to search for a new way in the further treatment of peripheral nerve injuries. Forty-five adult male Wistar rats received a neurotomy to bilateral sciatic nerves, which were subsequently reconnected with 10/0 epineurial nylon sutures. The injured segments was locally injected with normal saline (group A), or 25 microg of phVEGF(165) (group B) or 50 microg phVEGF(165) (group C). Nerve conduction and regeneration were evaluated in terms of the histological changes, weight of gastrocnemius muscles, electrophysiology and morphometric results. Our study demonstrated that rats of group C showed the best results in terms of nerve regeneration, followed by group B and group A. Our findings suggested that local injection of phVEGF165 can facilitate nerve regeneration and promote functional recovery in a dose-dependent manner.

This study is to investigate the effect of local phVEGF165 injection on sciatic nerve regeneration in the rats and to search for a new way in the further treatment of peripheral nerve injuries.Forty-five adult male Wistar rats received a neurotomy to bilateral sciatic nerves, which were subsequently reconnected with 10/0 epineurial nylon sutures. The injured segments was locally injected with normal saline (group A), or 25 μg of phVEGF165 (group B) or 50 μg phVEGF165 (group C).Nerve conduction and regeneration were evaluated in terms of the histological changes, weight of gastrocnemius muscles, electrophysiology and morphometric results. Our study demonstrated that rats of group C showed the best results in terms of nerve regeneration, followed by group B and group A. Our findings suggested that local injection of phVEGF165 can facilitate nerve regeneration and promote functional recovery in a dose-dependent manner.

BACKGROUND: In repair of nerve defect with allogenic nerve graft, to reduce immune rejection is one of the key problems. At present, the main approach is to reduce antigenicity of grafted nerve segment and apply generally immune inhibitor.OBJECTIVE: To observe the effects of freeze/thaw treatment and local application of transforming growth factor beta 1 (TGF-β1) plasmid on frozen nerve allograft.DESIGN: Randomized controlled animal experiment was designed.SETTING: Department of Hand Surgery, Union Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology.MATERIALS: The experiment was performed in Tongji Medical College of Huazhong University of Science and Technology from January 2003 to December 2004, in which 40 Wistar healthy and adult rats were employed,from different delivery and were randomized into experimental group and control, 20 rats in each one.METHODS: Transforming growth factor-β1 (TGF-β1) plasmid and frozen allogenic sciatic nerve were prepared. In experimental group and control,sciatic nerve was cut off 2.0 cm in length, in the foramen 0.5 cm beneath piriformis. The nerve defect was repaired with pre-frozen allogenic nerve 2.0 cm in length. In experimental group, TGF-β1 plasmid was injected in local muscle and two broken ends of nerve. In the control group, physiological saline of equal volume was injected. In the 6th and 12th weeks, the samples were collected from 10 rats in each group for sectioning, staining,axonal counting and statistical analysis.RESULTS: No any animal was died in experiment and all of animals entered result analysis. In the 6th weeks, in the control group, mild edema appeared among axons on the grafted segment of nerve and in the experimental group, there was no edema among axons and the regenerated nerve numbers were close to the normal. In the 12th week, in the experimental group, the entire grafted nerve segment was basically filled up by the regenerated axons;myelinated nerve fiber was arranged in order and both axons and myelins were developed well. The regenerated axonal count in experimental group was more significantly than the control, indicating extremely significant difference [(98.6±4.8), (75.8±5.1) counts/μm2, t=2.962, P ＜ 0.01].CONCLUSION: Freeze/thaw treatment can decrease antigenicity of allogenic nerve, which provides the possibility of repair of nerve defect. Local application of TGF-β1 plasmid can provide immune inhibition locally and reduce immune rejection in the host.

[Objective]To study the effect of End-to-side neurorrhaphy for protection target muscle.[Method]Twenty-six wistar rats were divided into two groups,with 13 in each group,peroneal nerve was transacted on the right side of all the animals,in one group,the proximal end of peroneal nerve was turned back and ligated,the distal end was sutured to the side of tibial nerve with perineurial window,in another group,both ends of the transacted peroneal nerve were turned back and ligated as contrast,no operation was done on the left side.Three months after operation,the peroneal nerve and the tibial muscle were taken for histologic exmination,and the muscle's wet weight was examed.[Result]Significant difference was seen between the two groups in the muscle wet weight,the muscle fiber cross sectional area,the moter endplate area and color(P