Volume 89  ·   Issue 35  ·  2009

Cataract is the first eye disease that causes blindness in China, but it is also an eye disease that can be restored by surgery. In the early 1980s, Professor Freeman of the United States and Professor Lu Daoyan of China introduced and introduced modern extracapsular cataract extraction technique to China for the first time. The surgical incision is 11 mm.

The treatment of cataract, as the blinding eye disease with the highest incidence rate, has attracted much attention. Although phacoemulsification has been widely carried out and become the mainstream surgery since its inception, due to the diverse pathogenesis and complicated condition of cataract, it often encounters extraordinary conditions in clinical practice, and improper treatment will cause serious consequences. Therefore, how to correctly deal with various complicated situations has become the skill that cataract surgeons must master.

Objective To investigate the incidence and related factors of retinal detachment(RD) after phacoumulsification cataract extraction and intraocular lens(IOL) implantation in an unselected patient group. Methods This retrospective review was comprised of 10 076 cataract patients(13 625 eyes)who had phacoemulsification cataract extraction and IOL implantation from December 1, 1998 to September 30, 2008. The patients were of different ages, gender, left or right eye and different type of cataracts. The incidence of postoperative RD was assessed and the relative risk factors were estimated using the Kaplan-Meier method. Results The average age was 67.22±15.10 years old with 4439 males and 5637 females. The difference between the numbers of men and women was statistically significant (χ2 = 142.44, P <0.01). A total of 6701 left eyes and 6924 right eyes showed no significant difference (χ2 =3.65, P =0.056). And 65.91% of these eyes were age-related cataract. During the post-operation observation period, 32 eyes of RD in 32 patients were observed from 10 days to 74 months post-operation. The ratio was 0.32% with an estimated risk (Kaplan-Meier) of 0.47% at 74 months. These results confirmed that myopia and increased axial length were significantly associated with RD (χ2= 14.55, P < 0.001) and recognized risk factors for RD such as high myopia, posterior capsular bag rupture and Nd : YAG capsulotomy. Among these 32 eyes, 31 eyes had one successful retina re-attaching operation(90.32%) and two eyes were given up because of post-operative relapse. Conclusion The incidence of RD increases after phacoumulsification cataract extraction and IOL implantation in an unselected patient group. Hypermyopia, posterior capsular bag rupture and Nd: YAG capsulotomy are possible risk factors of the RD.

Objective To study the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and determine the efficacy of reducing conjunctival bacteria with different methods. Methods A total of 135 eyes of 135 patients scheduled to undergo cataract surgery were randomized into 3 groups (45 each). They received topical prophylactic treatment with three different kinds of antibiotics (0.5% levofloxacin, 0.3% levofloxacin and 0.3% tobramycin). Each group was randomized into one-day group and three-day group. All the eyes underwent irrigation of fornices with 2.5% povidone-iedine (PVI) before surgery. Conjunctival cultures were obtained at various time points. Results The total positive rate of conjunctival cultures was 66. 7%. The eliminating rate of conjunctival bacteria in one-day groups were 72.7%, 72.7% and 61.1% (P = 0.667) while 70.0%, 70.0% and 55.5% in the three-day groups respectively (P = 0.751). Immediately after PVI irrigation, the eliminating rate in one-day groups added up to 86.4%, 77.3% and 88.9% (P = 0.564) as compared with 90.0%, 80.0% and 66.7% in the three-day groups respectively(P = 0.749). And there was no statistically significant difference between one-day groups and three-day groups in the eliminating rate of conjunctival bacterial after the topical antibiotic application.The MIC test revealed that the antibiotic sensitivity of Gram-positive cocci (G + C) to levofloxacin was 94.8% versus 74.1% to tobramycin (P =0.000) while the antibiotic sensitivity of Gram-negative bacillus (G-B) to levofloxacin was 94.4% versus 83.3% to tobramycin (P =0.289). Conclusion G + C accounts for the most among the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and there is no statistically significant difference in the efficacy of reducing conjunctival bacteria between the application of topical antibiotic for one day and for three days. Both G + C and G - B retain a high sensitivity to levofloxacin. Topical antibiotic in combination with 2.5% PVI irrigation further reduces conjunctival bacteria.

Objective To estimate the cataract surgical coverage and cataract surgery rate and to assess the visual outcome of cataract surgery among individuals aged at or over 50 years old in four rural populations from four different areas of western China. Methods This crnss-sectional study, performed during the period 2003-2005, used the method of cluster sampling and recruited 5562 persons aged 50 years old or above through household census. Standardized ocular examinations including visual acuity test, intraocular pressure measurement, slit-lamp and fundus examination were performed. The main outcome criteria were cataract surgical coverage, cataract surgery rate, complication rate and visual outcome after cataract surgery. Results Of individuals whit bilateral presenting visual acuity < 6/60 due to age-related cataract, the cataract surgical coverage was 54% in Qinghai. It was the highest among these four populations. The highest cataract surgery rate (CSR) value was 1551 in Qinghai and the lowest 143 in Guangxi during the period of 2000-2002. The overall intraocular lens implantation rate was 51.5% in 200 eyes with cataract surgery and 40.5% eyes with post-operative visual acuity < 6/60. The overall post-operative complication rate was 28%. Conclusion In the beginning of 21st century, the cataract surgical coverage in four rural populations aged 50 years old or above in western China was low and similar to the situation of the last decade in eastern China. Cataract surgical technique and low IOL implantation rate are the main causes for a poor visual outcome. To reduce the risks of cataract blindness, the clinicians should substantially improve the visual outcome as well as the number of cataract surgery.

Objective To evaluate the safety and efficacy of apical pedicle subtraction osteotomy (PSO) in the treatment of severe kyphoscoliosis. Methods The radiographic films of the 12 severe kyphoscoliosis patients treated with apical pedicle subtraction osteotomy were retrospectively reviewed, and the Cobb angles of the scoliosis and kyphosis and coronal trunk balance were measured and analyzed. Medical records and operation charts were reviewed to record any peri-operative complications. Results Twelve patients were included in this study, 4 males and 8 females, with an average age of 20.1 years old. Of the 12 patients, 2 were adult kyphoscoliosis and 10 were congenital kyphoscoliosis. The mean follow-up time was 9. 2 months. The mean fusion levels were 12 segments and the mean operation time was 5.0 hours. The mean estimated blood loss during operation was 1517 ml and the mean autotransfusion and allotransfusion were 780 ml and 1109 ml, respectively. The mean preoperative and postoperative coronal Cobb angle of the main curve was 100.9° and 48.8°, with an average correction rate of 51.8% (P = 0.000). The mean preoperative and postoperative sagittal Cobb angle of the kyphosis was 81.7°and 42.2°, with an average correction rate of 49.8% (P = 0.000). At final follow-up, the mean Cobb angles of the scoliosis and kyphosis were 50.7°and 46.0°, respectively, and no obvious correction loss was found (P = 0.763, P =0.698). The mean coronal trunk balance before, after surgery and at final follow-up was 16.3 mm, 14.7 mm, and 12.0 mm, respectively. Only 1 patient had trunk shift greater than 20 mm at final follow-up. After operation, two patients suffered from transient numbness and weakness of the unilateral lower extremity with complete recovery in one week. No spinal cord injury occurred. Conclusions Apical pedicle subtraction osteotomy can be easily performed in the treatment of severe rigid kyphoscoliosis with satisfactory correction results and few neurologic complications.

Objective To observe the different efficacies of intradiscal interventional therapy for patients with degenerative chronic discogenic low back pain and end-plate Modic changes through different types of injection and to evaluate the potential therapeutic value of intradiscal injection treatment for degenerative chronic discogenic low back pain with different types of end-plate Medic changes by using appropriate injection. Methods Patients with single segmental degenerative chronic discogenic low back pain proved by discography were classified as Modic type Ⅰ predominant change (including Medic Type Ⅰ & Modic type Ⅰ predominant mixed Type Ⅰ/Ⅱ) and Modic type Ⅱ predominant change (including Modic Type Ⅱ & Modic Type Ⅱ predominant mixed Type Ⅱ/Ⅰ) according to the end-plate Modic changes on MRI. All received the intradiscal injection treatment. Patients were divided into three groups: (1) A group (control group): intradiscal injection of normal saline 3 ml; (2) B group (treatment group): intradiscal injection of diprospan (compound betamethasone) 3 ml; (3) C group (treatment group): interventional injection of diprospan (compound betamethasone) 1 ml + songmeile (cervus & cucumis polypeptide injection) 2 ml. Pain and function were evaluated by pain visual analogue scale (VAS) and Oswestry disability index (ODI). T-test was applied for efficacy comparison in each group at pre-operation, 3 months and 6 months post-oporation. Results Sixty patients were included. There were 39 males and 21 females with a mean age of 41.6 years old (26-58). There were 10 patients in each group: A-Modic Ⅰ, A-Modic Ⅱ; B-Medic Ⅰ, B-Modic Ⅱ; C-Modic Ⅰ, C-Modic Ⅱ. There was no significant statistical difference in preoperative VAS and Oswestry scores among groups; VAS and Oswestry scores of B group and C group at 3 months and 6 months post-operation were significantly better than those pre-operative scores, and also better than that of control group (A group) at the same time. But there was no significant difference in scores between 3 months and 6 months in ether B group or C group, and there was also no significant difference in VAS and Oswestry scores between B group and C group at various time points. Various Modic types had no correlation with either VAS score or Oswestry score in each group at various time points. Conclusion Intradiscal interventional therapy can relieve discogenic low back pain and improve Oswestry disability index score of function between 3 and 6 months post-operation. There is no significant difference in post-operative efficacy between Modic Type Ⅰ and Medic Type Ⅱ. Steroids are the major analgesic factor of intradiscal injection. But the synergistic application of songmeile (cervus & cucumis polypeptide injection) can maintain the analgesic effect and duration with a decreased dose of steroids.

Objective To assess whether it is reasonable to downgrade intralobar metastatic non-small cell lung cancer from T4 disease through a prognostic analysis of N0-1M0 disease. Methods A retrospective analysis was conducted to assess the survival of patients with intralobar metastatic non-small cell lung cancer with pathological N0-1M0 disease. The Kaplan-Meier method was used to calculate the patient survival. Results Forty-six patients were included. The overall 5-year survival rate was 29.2% with a median survival of 53.0 months. The median survival was 24.0 months for patients with adenosquamous carcinoma; while for patients with other pathologic types, the median survival was 48 months. Adenosquamous carcinoma had a shorter survival time than other pathologic types (P = 0.003). The median survival time was 60.0 months for patients undergoing non-pneumonectomy resection and 24 months for patients undergoing pneumonectomy (P = 0.023). Conclusion It is reasonable to downgrade the T4 classification of non-small cell lung cancer with intralobar metastasis. However, pneumonectomy should be carried out with cautions. Adenosquamous carcinoma has a poor prognosis. Further study of a larger sample size is warranted.

Objective To establish a classification model and serum proteomic patterns in non-small cell lung cancer (NSCLC) patients with lymph node metastasis by surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS). Methods The relative contents of serum proteins of 84 NSCLC patients with different N stages (35 NO cases, 19 N1 and 30 N2 respectively) were detected by CM10 chip and SELDI-TOF-MS; two decision trees were generated to distinguish lymph nodes metastasis (N0 versus NI + N2) and mediastinal lymph nodes metastasis (N0 + N1 versus N2) respectively. Results The model in which 50 patients were randomly chosen differentiated patients with lymph nodes metastasis from NO patients with a sensitivity of 96.3% (26/27) and a specificity of 95.7% (22/23) in the training set, a following blind test was taken. Subsequently, compared with 49 patients with lymph node metastasis (N1 + N2), 15 patients with total negative lymph nodes (including lobar, segmental and subsegmental nodes necessarily) were defined as "true" NO and were chosen to form a better predictive model with a 77.6% (38/49) sensitivity and a 93.3% (14/15) specificity respectively. And 6682.0Da, together with other five proteins, hod significant difference between two groups; the result of this model for distinguishing the mediastinal lymph nodes metastasis is more accurate than thoracic CT analyses by Alongi F and many other clinical centers. It had a sensitivity of 80.0% (24/30) and a specificity of 77.8% (42/54) respectively. Conclusion SELDI-TOF-MS showed a potential value for predicting lymph nodes metastasis in NSCLC patients. And further studies are required to confirm the models and identify the related proteins.

Objective To study the proportion of regulatory T cells (Tregs) in peripheral blood of patients with rheumatoid arthritis (RA) and investigate the significance of Tregs change in the incidence and inflammatory activity of RA. Methods Three-color fluorescence flow cytometry was used to detect the CD4, CD25 and CD127 markers in the peripheral blood lymphocytes of 25 RA patients and 31 healthy volunteers (HVs). The proportions of CD4+CD25+, CD4+CD25high, CD4+ CD25+ CD127- and CD4+ CD25high CD127- cells were compared between the two groups and correlation analysis was conducted between Tregs and disease activity indices which including disease activity score (DAS28-4), tender joint count (TIC), swollen joint count (SJC), time of morning stiffness, patient's global assessment of disease activity on a 100 mm VAS by doctor and patients, erythrocyte sedimentation rate and C-reactive protein. Results The proportions of CD4+ CD25+ CD127- and CD4+ CD25highCD127- cells in CD4+ peripheral T lymphocytes were (2.53±0.85)% and (0.91±0.32)% respectively in RA group,while they were (3.22±0.97)% and (1.25±0.41)% in HV group. Both of the proportions of CD4+ CD25+ CD127- and CD4+ CD25high CD127- cells were lower in RA group comparing with HV group, and both were significantly different between the two groups (P < 0.05). Correlation analysis indicated signifieant negative correlations of the proportions of CD4+ CD25+ CD127- and CD4+ CD25high CD127- cells with DAS28-4 and TJC (P <0.05), furthermore, CD4+ CD25highCD127- T cells still showed siguifieant negative correlation with the SJC and patient's global assessment of disease activity on a 100 nun VAS by patients (P < 0.05). Conclusion The proportion of Tregs decreased in peripheral blood lymphocytes of patients with RA and the abnormality of Tregs may play an important role in the incidence and inflammatory activity of RA.

Objective To identify the correlation between the revised amyotrophic lateral sclerosis (ALS) functional rating scale (ALSFRS-R)and the progression rate of ALSFRS-R (△FS) at time of diagnosis and survival time in a prospective survey. Methods A total of 129 consecutive patents with definite or probable ALS were enrolled at our hospital from January 2002 to December 2005. The patients were monitored with a standard evaluation form recording clinical features, ALSFRS-R and forced vital capacity (FVC) every 3 months from visit to death or tracheostomy. Results The mean age at onset was (52±11)years old. The median survival time from symptom onset was 45.71 months (95% CI = 35 to 51). In univariate analysis of Kaplan-Meier method, the outcome was significantly related to total ALSFRS-R and △FS (P < 0.05). In Cox multivariate model, △FS and FVC% were both statistically significant predictors of survival after adjusting for age and onset site(P <0.05). Al-unit decrease in △FS was associated with a 73.3% decreased risk of death. Conclusion ALSFRS-R is sensitive to the change over time and can predict survival at diagnosis. It can be used as a primary outcome measure in ALS clinical trial. △FS at diagnosis can provide us the information of disease progression at one particular point. It is a more significant predictor of survival in patients with ALS as compared to total ALSFRS-R and time from onset to diagnosis.

Objective To investigate the feasibility and effectiveness of a social skills training program in children with child behavior disorders. Methods A total of 441 children, aged 7-13 years old, from 6 centers were randomized into intervention (n =216) and waitlist group (n =225). The social skills training program was offered to the intervention group 1 hour weekly for totally 12 weeks. The Rutter Parent & Teacher Scale and Achen-bach Child Behavior Checklist (CBCL) were used at baseline and completion of intervention. Results Change of total score, neurotic factor score and antisocial factor score of Rutter Parent Scale in the intervention group was significantly larger than that in the waitlist group(P =0.000, P =0.000, P =0.000). The clinical cure rate of the intervention group (47.69%) was significantly higher than that of the waitlist group (24.89%) after intervention (χ2= 24.84, P = 0.000). Change of total score, neurotic factor score and antisocial factor score of Rutter Teacher Scale in the intervention group was significantly larger than that in the waitlist group (P = 0.000, P = 0.003, P = 0.002). The clinical cure rate of the intervention group (56.02%) was significantly higher than that of the waitlist group (38.22%) after intervention (χ2= 14.01, P =0.000). The total score, somatic complaint score and delinquent score of Achenbach Child Behavior Checklist (CBCL) of the intervention group decreased significantly than that of the waithst group after intervention (P = 0.000, P = 0.000, P = 0.002) with the exception of aggressive behavior score (P = 0. 078). The difference and decrease rate of total score, somatic complaint score, delinquent score and aggressive behavior score of intervention group were significantly higher than that of the waitlist group after intervention(P = 0.000, P = 0.000, P =0.006, P = 0.015, P = 0.000, P = 0.000, P =0.000, P = 0.012). Conclusion This study provides supports for the use of social skills training program to improve children's behavior problems in both family and school settings.

Objective To observe the impact of artificial esophagus slipped time upon the function formation of neoesophageal channel, explore the scope of secure control time and assess the treatment methods of neoesophageal stenosis. Methods A total of 18 pigs in which artificial esophagus slipping at Month 1, 2, 3, 6 post-operation were observed with regards to complications, neoesophageal structures and functions and survival status of experimental animals. Results Three pigs had a slip of artificial esophagus within a month post-operation and severe eating difficulties(Bown's Grade Ⅳ)because the neoesophagus had a severe narrowing (φ < 0. 5 cm). All were dead shortly resulting from a failed treatment of esophageal dilation. Four pigs had a slip of artificial esophagus within 2 months post-operation. They all had dysphagia (Grade Ⅲ-Ⅳ)as a result of moderate or severe neoesophageal stenosis (φ 0.5-0.9 cm). Dysphagia was progressive. Repeated esophageal dilation was in vain. Three pigs were dead shortly and 1 pig achieved a long-term survival through a bare stent replacement therapy. Four pigs had a slip of artificial esophagus within 3 months post-operation. Dysphagia (Grade Ⅰ-Ⅱ) occurred as a result of mild or moderate neoesophageal stenosis(φ 0.9-1.5 cm). Two pigs with moderate dysphagia achieved a long-term survival through a bare stent replacement therapy while another two were sacrificed. Seven had a slip of artificial esophagus at 3 months post-operation. The neoesophagus showed expansion and a relative narrowing(φ 1.9 cm). Experimental animals had a mild difficulty in eating(Grade Ⅰ), but it had an automatic relief. Experimental animals achieved a long-term survival and did not advance further. Conclusion Artificial esophagus (implant) stays in place for 2-3 months to form a functional esophageal channel. The longer an artificial esophagus is in place, a better channel of neoesophagus will form. Resetting a bare stent treatment of serious neoesophageal stcnosis has significant therapeutic effects during this period. At 3 months post-operation, the slipping of artificial esophagus has little effects upon eating so that experimental animals may achieve a long-term survival.

Objective To study the roles of serum inflammatory factors IL-6 and TNF-α and allograft adventitial inflammation in the pathogenesis of allograft arteriosclerosis in rats. Methods Thirty-six allogeneic allograft rats and 16 syngeneic allograft rats were randomly divided into 4 groups (9 rats in each experimental group and 4 in each control group): A, harvested at Week 1 post-operation; B, harvested at Week 2 post-operation; C, harvested at Week 3 post-operation; D, harvested at Week 4 post-operation. Blood samples were collected before transplantation and after harvest. The method of ELISA was used for testing serum inflammatory factors including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), HE staining for pathologic changes of aortic allograft and immunohistochemical method for expression of α-actin, cyclin dependent kinase-1 (CDK1) and proliferating cell nuclear antigen (PCNA). Compare the inflammatory factors and other observations between groups and preoperative. Results At Week 1 post-operation, a large amount of inflammatory cell infiltration in adventitia was observed; at Week 2 post-operation, slight collagen fibers hyperplasia with inflammatory infiltration; at Week 4 post-operation, obvious odventitia thickening with a large number of smooth muscle cells, collagen fibers and inflammatory cells, smooth muscle cells migration from adventitia to intima. Expressions of α-actin, CDK1 and PCNA kept increasing with time in adventitia (P < 0.05). There was a significant increase in serum TNF-α level in Groups A, B, C and D, as compared with pre-operative basal level (P <0.01). There was no difference between controls and pre-operative basal level. IL-6 level slightly declined in the middle stage, but finally increased in experimental group B (P <0.0.5) while it significantly increased in Groups A, C, D (P <0.01). In the control groups A, B, C, it was higher than pre-operative level (P < 0.05). In experimental groups A, C, D, it had a significant increase as compared with controls (P < 0.01). Conclusions In abdominal aortic allograft models, obvious angiosclerosis was found in adventitia and intima in accordance with the severity of odventitial inflammation. Thus the inflammatory factors and inflammatory cell infiltration in odventitia are both involved in the pathogenesis of early allograft arteriosclerosis.

Objective To investigate the role of androgen in TNF-α and MCP-1 expression in RAW264.7 macrophage and its molecular mechanism. Methods (1) RAW264.7 macrophage was treated with 10-9 mol/L or 10-7 mol/L testosterone (T) and then subjected to the measurement of: ①the cellular expression of TNF-α and MCP-1 mRNA by RT-PCR; ②the expression of TNF-α and MCP-1 in cell culture supernatant by ELISA; (2) The expression of phospho-NF-κB after treatment with T was measured by Western blot. (3) Cells were pre-incubated with 10-4 mol/L PDTC (an inhibitor of NF-κB) for 1 hour, followed by T treatment. Expression of mRNA and supernatant levels of TNF-α and MCP-1 were measured by RT-PCR and ELISA. Results (1)① After a 6 h treatment with 10-9 mol/L or 10-7 mol/L T, the expression of TNF-α mRNA increased by 1.78 and 1.87 folds, MCP-1 by 1.58 and 1.66 folds respectively (all P < 0.05). ② Incubated with both concentration of T for 6 h showed no significant changes of supernatant levels of TNF-α and MCP-1. After a 24 h treatment, the levels of TNF-α and MCP-1 increased significantly (all P <0.05) while more significant increase was found in 10-7 mol/L T group (P < 0.05). (2) The expression of phospho-NF-κB (ser276) increased significantly after cells were treated with 10-7 mol/L T for 30 min (P < 0.05) and peaked at 60 min. (3) With 1 h PDTC pre-incubation, T (10-9 mol/L or 10-7 mol/L) treatment for 6 h led to a lower mRNA expression and 24 h led to lower supernatant levels of TNF-α and MCP-1 than those without (P < 0.05). However, both cellular and supernatant expression of TNF-α and MCP-1 with PDTC pre-incubation were still higher than those of blank controls (all P < 0.05, except for TNF-α in 10-9 mol/L T treatment). Conclusion Testosterone can increase TNF-α and MCP-1 expression in RAW264. 7 macrophage in vitro. Activation of cellular NF-κB by testosterone may be one of underlying molecular mechanisms.

Constipation is a common disease, which is more common in women than in men, while chronic constipation is mostly functional constipation, which has an extremely high incidence rate in adult females. At present, the epidemiological investigations of constipation in various countries around the world are based on the Rome II standard. The reports of different countries and regions are inconsistent, and the results of foreign investigations show that the incidence of functional constipation in adult females fluctuates between 2% and 34% [1].

Zheng Hong, director of the Department of Drug Policy and Essential Drug System of the Ministry of Health, said that the clinical guidelines for essential drugs are specially designed to guide medical institutions and medical staff to use drugs rationally, especially for medical staff in primary medical and health service institutions. The guidelines for essential drugs should cooperate with essential drugs, and medical institutions should know the basic pharmacological situation, clinical use methods and side effects of these essential drugs. The guidelines are to further standardize the drug use behavior of medical institutions and medical staff.

Parkinson's disease (PD) is a common chronic progressive neurodegenerative disease in middle-aged and elderly people. Levodopa, which is the "gold standard" of PD treatment, can significantly improve the motor symptoms and signs of PD.

A 52-year-old male was admitted to Peking Union Medical College Hospital on March 6, 2008 due to repeated fever for 5 months and joint swelling and pain for 3 months. He held his breath for 2 days. The patient developed fever without trigger 5 months ago, and the highest body temperature was 39.8℃, which was obvious in the afternoon, without chills or cough. Blood white blood cells and neutrophils (N) were increased.