Volume 87  ·   Issue 26  ·  2007

Diabetic Foot disease is one of the serious complications of Diabetes mellitus, and it is an important cause of disability and death in diabetic patients.Therefore, early diagnosis and correct treatment of diabetic Foot are very important.The slogan of the 2005 World Diabetes Aim issued by the International Diabetes Federation is "Diabetes and Foot Care", its purpose is to arouse the attention of the whole society to diabetic Foot disease.If proper prevention and timely treatment can avoid or reduce amputation caused by diabetic Foot disease, so as to achieve the purpose of saving life.

Diabetic lower limb ischemia is mainly a clinical symptom group caused by ischemia and hypoxia of distal lower limb tissues caused by arteriosclerosis occlusion in diabetic patients. Arteriosclerosis in diabetic patients has the following characteristics [1]: (1) It is more common; (2) The onset age is younger; (3) There is no gender difference; (4) lesions in a plurality of segments; (5) The lesion occurs more distally (aorto-iliac artery is hardly involved).

It is known that increased plantar pressure is an independent risk factor for foot ulcer, and a large number of clinical observations have confirmed that the correlation between the two is as high as 70% ~90%. The abnormal increase of plantar pressure is due to the direct destruction of tissues by mechanical pressure, occlusion of plantar capillary vessels, local ischemic destruction of tissues, and aseptic and enzymatic autolysis of tissues caused by repeated and continuous mechanical pressure, thus leading to foot ulcer.

In 1999, the World Health Organization defined diabetic foot as: foot infection, ulcer formation and/or deep tissue damage caused by neuropathy and different degrees of peripheral vascular disease of lower limbs in diabetic patients [1].

diabetic foot ulcer (DFU) refers to the wound of the ankle joint or the foot below the ankle joint of diabetic patients that lasts for more than 2 weeks. It is related to distal nerve abnormalities of lower limbs and perivascular lesions of different degrees, with or without infection [1]. DFU is a local prominent and worsening manifestation of chronic, progressive, systemic and metabolic lesions of diabetes mellitus, and it is a representative kind of chronic wound.

Objective to retrospectively analyze the clinical characteristics of 249 patients with deep infection of diabetic foot (DF), and to analyze the factors affecting wound healing. Methods According to the amputation and wound healing, 249 patients with deep infection of DF were divided into unamputated healing group (Group A), healing group after amputation (Group B), and unhealed group after amputation (Group C). The clinical data, laboratory parameters and feature of foot wound were compared and analyzed. Results The number of patients in group A was 107, group B was 114, and group C was 28. The age of patients in group A was lower than that in group B, group B was lower than that in group C (59±12) years, (67±11) years, (72±9) years (P<0.01). The high sensitivity C-reactive protein (hs-CRP) was (18±5) mg/L in group A, (13±5) mg/L in group B, and (7±6) mg/L in group C (P<0.01). The plasma albumin in group A was (32±7) g/L, (29±5) g/L, (28±3) g Severe lower limb ischemia was 7%, 37% and 77% in group A, B and C, respectively, and the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that hs-CRP and serum albumin were the protective factors of wound healing, and old age, purulent secretion, detectable bone, bone exposure, edema, foul odor, necrosis and severe lower limb ischemia were the risk factors of wound healing. Conclusion All patients with deep diabetic foot infection need surgical treatment, even if they receive comprehensive treatment by a multidisciplinary team of diabetic foot, some patients still need amputation.

Objective to investigate the parameters, distribution and influencing factors of plantar pressure in patients with diabetes mellitus (DM) in China. Methods 1035 patients with DM and 1022 normal subjects were subjected to one-step method to measure the dynamic plantar pressure of each foot five times. The plantar was divided into 10 regions (heel, arch, first to fifth metatarsal head, first toe, second toe, third to fifth toe), and the mean maximum peak plantar pressure (MPP) and the mean maximum pressure of each part were calculated. Results the MPP of left and right feet of DM patients were (410 ± 122) kPa and (427 ± 128) kPa, and that of normal subjects were (415 ± 113) kPa and (428 ± 116) kPa. The difference between the two groups was not statistically significant. The top three MPP distributions of left and right feet in the two groups were: first toe>second metatarsal>third metatarsal. There was no statistically significant difference in MPP of DM patients with different course of diabetes, sex, age, body mass index, waist-hip ratio and history of ulcer. Especially in the second and third metatarsal heads, but the difference of MPP between DM patients with or without peripheral neuropathy is not statistically significant. Conclusion There is no statistically significant difference in plantar pressure between DM patients and normal subjects, but the distribution is different from that of normal subjects.

Objective to analyze the technique of interventional therapy for diabetic lower limb vascular lesions and observe the short-term efficacy. Methods 150 patients (176 affected limbs) with Fontaine grade Ⅰ ~ Ⅳ diabetic lower limb lesions admitted from August 2005 to February 2007 were retrospectively analyzed. The main treatment was balloon dilatation. The success rate, complications, clinical efficacy, ankle/brachial index (ABI) and treatment of vascular restenosis were observed. Results 150 patients (176 affected limbs) underwent 187 interventional treatments, and 161 affected limbs were successfully treated. The success rate of operation was 91.4%, without serious complications. The clinical symptoms of the patients were significantly improved after operation. The ABI of all patients before operation was 0.34±0.27 and the postoperative ABI was 0.96±0.24. A total of 134 patients (153 affected limbs) were followed up after operation, with an average follow-up of 5 months (1~16 months). The ABI ratio at 1 and 6 months after operation was 0.88±0.34 and 0.71±0.26, respectively. Ultrasound examination showed that 21 patients (13.7%) were treated for vascular restenosis or occlusion during the postoperative follow-up period. 11 cases (7.2%) underwent interventional therapy again. Conclusion Interventional therapy for diabetic lower extremity arterial lesions has higher success rate, lower complications and definite curative effect, and can be regarded as the first choice for diabetic lower extremity arterial lesions.

Objective to investigate and analyze the risk factors of diabetic foot disease in some hospitals in southern and northern China. Methods the socio-demographic characteristics, metabolic indexes, length of hospitalization and medical expenses of outpatient and inpatient diabetic foot disease in 14 tertiary hospitals in 2004 were collected and analyzed in southern and northern regions. Results Among the 634 patients, 285 were in southern and 349 were in northern regions. The patients in northern and southern regions had age (70 vs 66 years), family per capita monthly income>1000 yuan (57.7% vs 45.6%), coronary heart disease (42.6% vs 61.0%) and retinopathy (35.7% vs 49.5%), glycated hemoglobin (7.90% vs 8.80%), low density lipoprotein cholesterol (2.75 mmol/L vs 2.98 mmol/L), white blood cells (6.70×109/L vs 7.40×109/L), hematocrit (HCT: 0.37 vs 0.38), creatinine (87.00 μ mol/L vs 76.00 μ mol/L), uric acid (332.54 μ mol The difference of foot cure rate (19.1% vs 10.3%) and amputation rate (2.6% vs 9.7%) was statistically significant, but there were no statistical differences in the course of diabetes mellitus, course of podiatry, education level, smoking rate, hypertension, combined rate of renal lesions and peripheral neuropathy, fasting and postprandial blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol, platelet and urea nitrogen between the north and south. The results of Logistic regression analysis showed that the factors affecting the severity of diabetic foot in the south region were ankle-brachial index (ABI) and white blood cells, while the factors affecting the severity of diabetic foot in the north region were ABI, platelet and HCT. Conclusion The age of diabetic foot patients in the north region was young, the course of diabetes mellitus was long, and the course of podiatry was short.

Objective to investigate the changes of main biological functions and ultrastructure of fibroblasts (FB) in deep second degree scald wounds of diabetic patients (DM) and the pathological relationship between the changes and the delay of wound healing of DM. Methods 80 SD rats were randomly divided into normal control group and diabetic group. Wound skin tissue samples were collected in each group before scald and 3, 7, 14 and 21 days after injury, respectively. The content of hydroxyproline (OHP) in wound tissue was determined by chloramine T oxidation method; The proportion of Ⅰ/Ⅲ collagen was determined by ELISA; The expression of α-actin (α-SMA) was detected by SP immunohistochemistry; Results the cells in G0/G1 phase were lower in DM rats before scald (66% ± 5% in DM group and 82% ± 10 in normal group, P<0.01), and the proportion of cells in G0/G1 phase at each time point after scald was higher than that in normal rats (70% ± 4% in DM group and 42% ± 13% in normal group, P<0.01), and the cells in S phase were lower than that in normal rats (P<0.05, P<0.01). The OHP content per unit area of skin tissue of DM rats was lower than that of normal rats before scalding (0.72 μ g/cm2±0.06 μ g/cm2 in DM group and 1.42 μ g/cm2±0.28 μ g/cm2 in normal group, P<0.01) and after scalding (all P<0.01), and the proportion of collagen Ⅰ/Ⅲ in wound was significantly higher than that in normal group at 7, 14 and 21 days after scalding (5.54% ± 0.47% in DM group and 4.01% ± 0.32% in normal group, P<0.01); The expression of α-SMA in DM group was delayed and increased slowly, and the peak values at all time points after injury were lower than those in normal group; After injury, the endoplasmic reticulum of dermal fibroblasts in DM group was expanded, Golgi complex was underdeveloped, microtubules and microfilaments were lacking, and lysosomes in cytoplasm increased obviously. Conclusion The delay of wound repair in DM may be related to abnormal proliferation of FB, weakened collagen synthesis, insufficient expression of α-SMA and ultrastructure changes of FB.

Objective to observe and analyze the recurrence of chronic hepatitis B viral (CHB) after combined response by recombinant alpha interferon (rIFN-α) therapy, and the recurrence after rIFN-α therapy again during long-term follow-up. Methods 523 patients with CHB confirmed by liver biopsy were treated with rIFN-α 1b, 5 million U each time, 3 times a week, for 6~37 months (median 10 months). Liver function, HBV DNA and hepatitis B e antigen (HBeAg) were measured every 1~3 months during the treatment. Follow-up for at least 12 months after treatment. Liver function, HBV DNA and HBeAg were checked every 3 to 6 months at follow-up. The recurrent cases were treated with rIFN-α for the second time. Results 523 patients were treated with HBeAg (+) in 403 cases and HBeAg (-) in 120 cases. After the initial rIFN-α treatment, there were 225 cases (55.8%) in the HBeAg (+) group and 77 cases (64.2%) in the HBeAg (-) group, but the difference was not statistically significant (x2=2.633, P =0.105). In 302 recent respondents, after follow-up (39 ± 22) months, 119 cases (39.4%) had recurrence, including 76/225 cases (33.8%) in the HBeAg (+) group and 43/77 cases (55.8%) in the HBeAg (-) group, and the difference was statistically significant (x2=19.335, P =0.000). According to the follow-up every 12 months as a time period, it was divided into 6 time periods: 1-12 months, 13-24 months, 25-36 months, 37-48 months, 49-60 months and ≥61 months. The incidence of recurrence in each time period was statistically different The difference was statistically significant (x2=5.592, P =0.018). Conclusion After initial rIFN-α treatment, the short-term response rate of HBeAg-negative group and HBeAg-positive group was the same, while the recurrence rate of HBeAg-negative group was higher than that of HBeAg-positive group in CHB patients. All relapsed patients obtained combined response at the end of the second rIFN-α treatment, while the second relapse HBeAg-negative group was lower than that of HBeAg-positive group.

Objective to investigate the pathological and clinical characteristics of chronic hepatitis patients with negative serological markers. Methods 62 patients with hepatitis with negative serological markers and repeated abnormal liver function were examined by serum hepatitis virology, liver puncture pathology and immunohistochemical examination, liver function and coagulation function, and the serum hepatitis B virus DNA (HBV DNA) was detected by fluorescence quantitative PCR. Results The coincidence rate of clinical diagnosis and pathological diagnosis was 53.2% in 62 patients, and the coincidence rate of mild chronic hepatitis was 69.1%. The immunohistochemical examination of liver tissue in 62 patients showed that 28 patients (45.2%) were positive for HBsAg and/or HBcAg, which could confirm the diagnosis of hepatitis B. All 28 patients with hepatitis B had inflammatory lesions in liver tissue pathology, among which G1 was the highest in 13 cases (46.4%), followed by G2 in 10 cases (35.7%), and G4 in at least 2 cases (7.1%); S0 was found in 12 cases (42.9%), S1 was found in 7 cases (25%), and S4 was found in at least 1 case (3.6%). Serum HBV DNA was detected in 10 cases (35.7%) of 28 patients (3.3±2.2) ×103 copies/ml). There was no significant difference in the quantitative levels of serum HBV DNA between the groups of liver inflammation grade and fibrosis stage (P>0.05). There was no significant difference in the indexes of HBV DNA positive and negative patients (P>0.05). There was no significant difference in the indexes of hepatitis B patients and non-hepatitis B patients (P>0.05). Conclusion HBV infection with negative serological markers is still one of the main causes of unexplained liver diseases in China, and most of them are chronic hepatitis. HBV DNA replication is still low, the clinical manifestations are mild, the inflammation grade and fibrosis degree are mild, but it can still develop into cirrhosis.

Objective to compare the clinical characteristics and prognosis of hepatitis B virus e antigen (HBeAg) negative and HBeAg positive patients with hepatitis B cirrhosis. Methods to observe 217 patients with hepatitis B cirrhosis at 35 months (3-47 months), and to compare the clinical characteristics and prognosis of HBeAg negative and HBeAg positive patients with hepatitis B cirrhosis. Results In the observed population, HBeAg negative hepatitis B cirrhosis was more than HBeAg positive hepatitis B cirrhosis; The median levels of alanine aminotransferase and aspartate aminotransferase in HBeAg-negative patients were lower than those in HBeAg-positive patients; The median leukocyte, hemoglobin and platelet levels of HBeAg-negative patients were lower than those of HBeAg-positive patients; The positive rate of HBV DNA in HBeAg-negative patients and the proportion of patients with HBV DNA>105 copies/ml were lower than those in HBeAg-positive patients; The mortality rate of HBeAg-negative hepatitis B cirrhosis patients was higher than that of HBeAg-positive hepatitis B cirrhosis patients; In the group of HBeAg-negative patients, the incidence of ascites, hemorrhage and liver cancer in patients treated with oral lamivudine was lower than that in patients without antiviral therapy. The proportion of patients without cirrhosis-related complications in the whole study period was higher than that in patients without antiviral therapy, but the proportion of patients with 1~2 complications was lower than that in patients without antiviral therapy. In HBeAg-positive patients, the incidence of ascites in patients treated with oral lamivudine was lower than that in patients without antiviral therapy, and the proportion of patients without liver cirrhosis-related complications in antiviral therapy was higher than that in patients without antiviral therapy. Conclusion The biochemical indexes, peripheral blood cell count and HBV DNA load in HBeAg-negative patients with liver cirrhosis were lower than those in HBeAg-positive group.

The patient, a 46-year-old woman, was found to occupy liver space by B-ultrasound, and reported no discomfort. She was found to have high blood pressure for half a year. She took Baixintong to reduce blood pressure, and her blood pressure was controlled, and there was no history of oral contraceptives. Physical examination showed that the body temperature was 36.9 ℃, there was no yellowing stain on the skin and sclera, and there was no tenderness in the abdomen. Laboratory examination showed that there was no abnormality in blood routine, all five items of hepatitis B were negative, and there was no abnormality in liver function, alpha-fetoglobulin (AFP) 1.4 μ g/L and carcinoembryonic antigen (CEA) 2.6 μ g/L. B-ultrasound showed a hypoechoic mass in the left liver with clear boundary and uniform internal echo. CT plain scan showed a circular low-density mass with unclear boundary of about 42 mm ×45 mm ×46 mm in the fourth segment of the liver, with uniform internal density and CT value of about 29.7 HU (Figure 1A); The arterial lesions in the enhanced scan were significantly uniformly enhanced, the CT value was about 132.1 HU, the edges of the lesions were not smooth, and small nodular protrusions were enhanced, which showed that a blood supply artery was connected to the lesions (Figures 1B and 1C); Enhanced envelope shadow was observed at the edge of the lesion in the portal vein stage, and the internal density of the lesion was slightly higher than that of the liver parenchyma (Figure 1D); After 5 min delay, the internal density of the lesion was relatively low, and the density of the marginal capsule was slightly higher, showing annular enhancement (Figure 1E).

Objective to investigate the evolution of cerebral lesions in patients with autosomal dominant cerebral arteriopathy (CADASIL) with subcortical infarction and leukoencephalopathy by magnetic resonance (MRI). Methods the MRI findings of 7 patients from the same CADASIL family were retrospectively observed before and after 3 years. The distribution, size and morphology of various lesions in the brain were studied by modified Scheltens semi-quantitative score method. Results the white matter damage in 6 of 7 patients in this group was aggravated to varying degrees, which showed that the number and volume of lesions increased, and some of them fused into masses or chains, among which 6 cases, 5 cases, 3 cases and 2 cases showed changes in parietal, temporal, frontal and occipital lobes, respectively. There were 5 cases of fresh lacunar infarction, with the number of lesions ranging from 1 to 5; The lateral ventricle was slightly enlarged in one case, and both the lateral ventricle and the third ventricle were enlarged in the other case.Conclusion MRI can reveal the evolution of intracerebral lesions in CADASIL patients, which is of great value in clinical judgment of disease progression and prognosis.

Objective to evaluate the efficacy of prostatic digital cleavage in the treatment of bladder outlet obstruction (BOO) caused by small volume prostatic hyperplasia (<30 g). Methods 36 patients with BOO caused by small volume prostatic hyperplasia underwent prostatic digital cleavage. The changes of international prostatic symptom score (IPSS), maximum urine flow rate (Qmax) and residual urine volume (PRV) before and after treatment were compared to evaluate the efficacy of this procedure. Results All patients underwent prostatic digital cleavage. IPSS decreased from 14.19 ± 5.35 before operation to 5.03 ± 2.66 after operation (P<0.001), Qmax increased from preoperative Qmax (6.19 ± 2.14) ml/s to postoperative (17.71 ± 4.10) ml/s (P<0.001), and PRV decreased from preoperative (50.58 ± 14.84) ml to postoperative (8.53 ± 4.78) ml (P<0.001). A total of 33 patients were followed up, with an average follow-up of 32 months (9~52 months). Conclusion Prostatic digital cleavage is an ideal method for the treatment of bladder outlet obstruction caused by small volume prostatic hyperplasia.

Objective to analyze the characteristics of laser Raman spectra of visible region of gastric cancer serum and gastric cancer cell culture medium, analyze their dose-effect characteristics, and explore the source of specific Raman peaks. Methods 25 serums of gastric cancer and 10 serums of patients with functional dyspepsia (FD) were analyzed by laser Raman spectrometer; SGC7901 gastric cancer cell culture medium and lysates were detected at different time points. Results The repeatable Raman peak was detected in patients with gastric cancer at 583, 633, 656, 674, 707, 773 and 799 nm. The repeatable Raman peak was detected in patients with gastric cancer at 633, 656, 674 nm, but no identifiable Raman peak was detected in patients with FD. The fluorescence intensity of gastric cancer serum at the remaining 4 wavelengths (96.5±6.0, 76.9±4.7, 63.7±4.5, 285.7±18.6) was significantly higher than that in FD control group (40.3±1.8, 27.9±1.9, 22.9±1.4, 113.2±7.7, all P<0.01). Taking 100 as the minimum peak height, Raman peaks could be detected in gastric cancer cell culture medium at 633, 656 and 674 nm, but not at 1640 nm; The Raman peak height of gastric cancer cell culture medium at 583, 707, 773 and 799 nm was significantly higher than that of 1640 medium, and the Raman peak height of gastric cancer cell culture medium at the above 7 wavelengths was positively correlated with the culture time (Pearson correlation coefficients were 0.845, 0.875, 0.875, 0.873, 0.805, 0.891 and 0.880, respectively, all P<0.01); The difference of Raman peak of gastric cancer cell lysates and cultures at 583, 633 and 656 nm was statistically significant (11.1 ± 3.2, 5.0 ± 0.9, 3.3 ± 0.5, all P<0.05). Conclusion the serum of gastric cancer patients has specific and repeatable laser Raman spectroscopy. The difference of metabolites and lysates of gastric cancer cells at different concentrations can be detected by laser Raman spectroscopy. The cellular contents released by gastric cancer cells after apoptosis, such as DNA and RNA, may directly participate in the formation of serum Raman spectra of gastric cancer.

Objective to investigate the correlation and clinical significance of HER-2 and P53 protein expression in breast carcinoma. Methods 2996 cases of primary breast cancer were hospitalized from July 2002 to November 2005, aged 15-92 years, with a median age of 50 years. All of them were confirmed by surgical resection and pathological histology. Estrogen receptor (ER), progesterone receptor (PR), epidermal growth factor receptor 2 (HER-2) and P53 protein were detected by immunohistochemical SP method. The correlation was calculated by chi-square test and multivariate stepwise regression. Results 2316 cases (77.3%) of HER-2 overexpression were negative, 680 cases (22.7%) of HER-2 overexpression were positive, 378 cases (12.6%) of HER-2 overexpression were weak positive (+ +), 302 cases (10.1%) of HER-2 overexpression were strong positive (+ + +), 935 cases were positive for HER-2, 2061 cases were negative for HER-2 overexpression, 32.2% of HER-2 overexpression were positive for HER-2 and 18.4% of HER-2 overexpression were negative for HER-2 (P<0.01)

Objective to develop a high-risk human papillomavirus (HPV) 16,18 nucleic acid detection quality control which can simulate real clinical specimens, and to explore its effectiveness in interlaboratory quality evaluation in clinical laboratory. Methods Recombinant plasmid vector containing HPV-16 target gene was obtained by molecular cloning method, transfected into cervical cancer epithelial cell line (HeLa) containing HPV-18, and obtained the epithelial cell stock solution containing HPV-16,18 nucleic acid, which was properly inactivated and fixed with methanol. After the stock solution was properly diluted, a sample tray containing 12 negative and positive samples was formed, and sent to all laboratories in China to carry out clinical HPV-16,18 detection, and the returned results were analyzed. Results The cell stock solution was diluted 1:10, 1:50, 1:100, 1:500, and detected by real-time fluorescence PCR. The Ct values of HPV-16 were 29.10, 31.19, 32.15 and 32.73, and the Ct values of HPV-18 were 30.32, 32.13, 32.22 and 35.55, respectively. The quality control substance could be stable at 4 ℃ for more than 40 days, and the results were blind mailed to Urumqi, Xinjiang and Hohhot, Inner Mongolia The coincidence rate of HPV-16,18 nucleic acid detection was 57.4% for low concentration samples and 98.3% for negative samples. Conclusion The quality control substances of HPV-16,18 nucleic acid detection which can simulate clinical samples were obtained, and the quality evaluation results showed that they can be effectively used for interlaboratory quality evaluation in clinical laboratories.

Objective to observe the involvement of bFGF in the protection of ischemic myocardium by basic fibroblast growth factor (bFGF) and myocardial ischemia (MI) groups (bFGF + MI group, bFGF injection in ischemic marginal area), MI group (equal volume normal saline injection in ischemic marginal area) and sham operation group (sham group). The experiment was completed at 24 h, 14 d and 28 d after infarction, respectively. The hemodynamic parameters were measured, the myocardial infarction area was measured by red tetrazole method, the number of microvessels was counted by immunohistochemistry, the expression of bFGF was detected by real-time quantitative PCR, and the changes of FAK and p-p38MAPK were detected by Western blot. Results After injection of bFGF at the margin of ischemic area, the myocardial function was improved, the myocardial infarction area was decreased compared with MI group, the number of microvessels was increased compared with MI group, the expression of bFGF was increased in the ischemic marginal area and infarct area, and the expression of FAK and p-p38 was up-regulated. Conclusion bFGF significantly improved the myocardial function after acute myocardial infarction in rats Its cellular signaling mechanism is involved in the activation of FAK and the p38MAPK signaling pathway.

Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) is the transcription template of hepatitis B virus pregenome RNA (pgRNA), which is of great significance to the circulation replication of HBV and the establishment of infection status [1]. Re-understanding the process of HBV infection and clearance from the perspective of cccDNA will help to clarify some ambiguous concepts, deeply understand the pathogenic mechanism of HBV, and more rationally determine the strategies and targets of antiviral therapy, and may bring new enlightenment in more profound fields such as prevention and treatment of post-transplantation hepatitis recurrence.

Retinal degenerative disease is a kind of fundus disease caused by progressive loss of visual acuity and eventually loss of blindness. Nowadays, the main methods for treating retinal degenerative disease in the world include retinal transplantation (including retinal cell transplantation, slice transplantation, full-thickness transplantation, etc.), artificial retina implantation, gene therapy and drug therapy, etc. Among them, the basic research and clinical application of retinal transplantation in the treatment of retinal degenerative disease have been the most popular and deep in recent 10 years. However, the detection of visual electrophysiological conduction function between donor and recipient and the formation of synaptic interface between donor and recipient have been the unresolved focus problems for many years.

In patients with stable coronary artery disease, whether percutaneous coronary intervention (PCI) combined with intensive drug therapy and lifestyle intervention can reduce the risk of cardiovascular events better than drug therapy alone is still unknown.Therefore, a randomized controlled study, namely the evaluation of clinical outcomes of vascular recanalization and potent drug therapy (COURAGE), conducted by United States Department of Veterans Affairs and the Canadian Institutes of Health, showed that PCI plus optimal drug therapy is no better than optimal drug therapy alone in stable coronary artery disease.

A 79-year-old male was admitted to hospital due to repeated upper abdominal dull pain and discomfort for 8 years, and the symptoms aggravated to persistent pain in the past 1 month. After eating, there was no fever, and the weight loss was not obvious. Gastroscopy in the local hospital showed nodular bulge of gastric mucosa with multiple ulcers, gastric cancer? Biopsy showed no cancer cells. After transfer to our hospital, gastroscopy and pathological biopsy showed that gastric mucosa-associated B-cell lymphoma, CD20 (+ + +), Helicobacter pylori (HP) (-). Endoscopic ultrasound showed that the mucosa and submucosa of the gastric wall of the gastric fundus were obviously irregularly thickened, the mucosal layer was incomplete, the submucosa showed diffuse hypoechoic mass shadow, and the lamina propria was normal. Abdominal B-ultrasound and superficial lymph node B-ultrasound showed no obvious enlarged lymph node sonography, liver and spleen were not large.