Table of Content

21 January 2017, Volume 38 Issue 1

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Strategies for management of high risk nondisabling cerebrovascular events

Wang Yilong, Zhao Xingquan, Wang Yongjun

2017, 38(1):  1-5.  doi:10.3969/j.issn.1006-7795.2017.01.001

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Cerebrovascular events have become the most common cause for death or dependency of Chinese population. Risk assessment model for stroke recurrence was insufficient and effective treatment strategy was lacking. Prof. Yongjun Wang et al carried out a population-based survey and a cohort study with large sample, presented the concept of "high risk patients with acute nondisabling cerebrovascular events", established a risk accessment system for stroke, and found a new dual antiplatelet method which significantly decreased the risk of stroke recurrence by 32% without increasing bleeding events. The new method had been applied in the clinical practice widely, decreased stroke recurrence in 740 000 cases and reduced medical cost by 15 billion yuan.

Relationship between branch retinal vein occlusion and internal carotid artery elasticity

Li Shuang, Wang Wei, Hong Hui, Zhao Lu, Wang yanling

2017, 38(1):  6-10.  doi:10.3969/j.issn.1006-7795.2017.01.002

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Objective To investigate the relationship between BRVO (branch retinal vein occlusion) and internal carotid artery elasticity. Methods For patients with BRVO who presented to Beijing Friendship Hospital between January 2014 and November 2014, 92 eyes of 92 patients were assigned as the participants,56 patients with BRVO were assigned as the BRVO group,36 patients were enrolled as control.All the participants were examined with color Doppler ultrasonography, these indexes were systolic diameter(Ds),diastolic diameter(Dd), peak systolic velocity(Vs), end diastolic velocity(Vd),mean velocity(Vm),intima-media thickness(IMT) and plaque formation.These values were calculated:the internal carotid artery elastic parameters by relevant formula; wall motion degree(ΔD),arterial tension,arterial expansion,pressure-strain elastic modulus(Eρ),stiffness index(β),arterial compliance(AC)and resistance index(RI), internal carotid artery elasticity parameters and other index.Results Carotid plaque detection rate,internal carotid artery stenosis rate and intima-media thickness(IMT)of BRVO group were significantly higher than those of control group(P<0.05),wall motion degree(ΔD),arterial tension,arterial expansion,pressure-strain elastic modulus(Eρ),and arterial compliance(AC)of BRVO group had significant differences compared with control group(P<0.05), resistance index(RI), mean velocity(Vm) and stiffness index (β) of BRVO group have no significant differences compared with control group(P>0.05).Conclusion The detection of carotid artery hemodynamic parameters for patients with branch retinal vein occlusion is important, there is a relationship between BRVO and internal carotid artery elasticity.

Diagnosis of dry eye disease using keratograph 5M

Tian Lei, Song Wenxiu, Wang Zhiqun, Zhang Yang, Sun Xuguang

2017, 38(1):  11-16.  doi:10.3969/j.issn.1006-7795.2017.01.003

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Objective To compare the noninvasive Keratograph tear breakup time (NIKBUT) and tear meniscus height (TMH) of patients with dry eye disease (DED) and healthy control subjects using Keratograph 5M (K5M) and to investigate the role of NIKBUT and TMH in the diagnosis of DED. Methods In this prospective study, 110 eyes with DED (DED group) and 108 healthy control eyes (Control group) were enrolled. All subjects completed the Ocular Surface Disease Index (OSDI) questionnaire. NIKBUT, which included the first NIKBUT (NIKBUTf) and average NIKBUT (NIKBUTav), and TMH were measured by K5M. The fluorescein tear breakup time (BUT), corneal staining and SchirmerⅠ test were also applied. All parameters were compared between the DED and Control groups. The receiver operating characteristic curves (ROC) were plotted to distinguish DED from the normal eyes. Results There were significant difference between DED and Control group for the values of OSDI, BUT, corneal staining score and Schirmer Ⅰ test (all P<0.001). In the DED group, the NIKBUTf, NIKBUTav and TMH were (5.9±3.96) s, (8.07±4.34) s and (0.22±0.06) mm, respectively; while in the Control group, the values were (8.78±4.33) s, (12.67±4.43) s and (0.28±0.09) mm, respectively (between the two groups, all P<0.001). For ROC analysis, the area under the curve (AUC), sensitivity and specificity were 0.740, 80% and 67.59% for NIKBUTf; 0.798, 64.55% and 83.33% for NIKBUTav; 0.660, 33.63% and 94.44% for TMH, respectively. For the combo of the three parameters, the AUC, sensitivity and specificity were 0.829, 67.3% and 86.1%, respectively. Conclusion Keratograph 5M offers an effective method for measuring NIKBUT and TMH properties of both patients with DED and healthy subjects. The three parameters exhibited significant differences between the two groups. Although the diagnostic efficiency was poor with NIKBUT or TMH alone, but the combined parameter showed a high sensitivity for the diagnosis of DED, with practical clinical application.

Experimental primate animal models for age related spontaneous eye diseases

Teng Yufei, Liu Xiyao, Peng Xiaoyan, Zhang Jingxue

2017, 38(1):  17-23.  doi:10.3969/j.issn.1006-7795.2017.01.004

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Objective To screen the pathologic changes of retina of old monkeys to establish a spontaneous eye disease model for age related eye diseases. Methods Thirty-nine cynomolgus monkeys (age:11.9±2.05, min=9; max=17) and 13 macaques (age:15.5±5.2, min=7; max=24) were used to perform eye examination including fundus, and intraocular pressure(IOP). Blood glucose was evaluated through glucose tolerance test (GTT). Non-mydriatic fundus camera was used to examine the pathogenic changes of retinal, the suspicious cases were then imaged by spectral-domain optical coherence tomography (SD-OCT) to evaluate the retinal structure. Results Three macaques and four cynomolgus were hyperglycemic, no diabetic retinopathy symptoms were any of the found in three animal. Thirteen cynomolgus and 6 macaques showed lens opacity in both eyes. The average IOP of cynomolgus was oculus dexter (OD):(15.98±3.315)mmHg (1 mmHg=0.133 kPa),oculus sinister (OS):(15.82±4.021)mmHg. The average IOP of macaque was OD:(14.9±3.867)mmHg, OS:(14.7±3.329)mmHg.One cynomolgus has high IOP in both eyes; fundus photo displayed an early change of glaucoma symptom. Fundus photography from 2 monkeys both eyes showed numerous drusen distributing throughout the whole retina. One retina displayed geographic serpiginous choroiditis in right eye.Conclusion In old monkeys eyes, macular degeneration, cataract, and glaucoma were observed with the symptom similar to those of human being. But no diabetic retinopathy (DR) symptoms was found in hyperglycemic cases, which may because the different pathologic change in primate animal or the pathologic change haven't occurred. Our study provided a primate animal source with spontaneous age related eye disease for studying the novel therapeutic agents or cell therapy for clinical trial.

Roles of p75^NTR inhibitor on retinal ganglion cells in a rat model of acute ocular hypertension

Wang Xiaolei, Ma Jianmin, Meng Zhaoyang, Yin Yi, Wang Yanling

2017, 38(1):  24-28.  doi:10.3969/j.issn.1006-7795.2017.01.005

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Objective To explore the role of p75^NTR inhibitor on suppressing retinal ganglion cells (RGCs) apoptosis in a rat model of acute ocular hypertension. Methods The acute ocular hypertension (AOH) rat model was established, and animals were divided into control (Ctrl), sham operation, AOH, AOH+TAT-Pep5 treated groups (1,3 and 5d subgroups). Immunofluorescent staining was performed to detect the expression of proNGF and p75^NTR. Western blotting was used to detect the protein expression levels of proNGF and cleaved-caspase 3. TUNEL assay was used to detect cell apoptosis. Results The expression of proNGF was increased in acute ocular hypertension model. When the p75^NTR was blocked by its inhibitor (TAT-Pep5), the number of death RGCs (TUNEL positive cell number) were less than that of AOH group. The results of Western blotting showed that the protein expression levels of cleaved-caspase 3 could be up-regulated in retina from AOH group or down-regulated in retina from AOH+TAT-Pep5 group when compared with that of Ctrl and AOH groups. Conclusion RGCs injury can increase proNGF expression. p75^NTR blockade can potentiate the survival of RGCs.

Observation of the changes of structure and function of the macular area after vitrectomy in patients with idiopathic macular hole

Hu Yanhua, Wang Yi, Liu Wu, Liu Limei, Gao Meng, Yan Weiyu, Liu Kegao, Liu Xinxin

2017, 38(1):  29-34.  doi:10.3969/j.issn.1006-7795.2017.01.006

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Objective To observe the changes of visual acuity, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) before and after vitrectomy in patients with idiopathic macular hole (IMH), and explore the sensitive indexes of structural and functional changes in these patients. Methods Data of 34 eyes of 34 patients who underwent vitrectomy from December 2013 to April 2014 in Beijing Tongren Hospital for idiopathic macular hole for IMH were collected. All patients were followed up for 6 months. Best corrected visual acuity(BCVA), mfERG and OCT were examined at baseline, 3 months and 6 months, respectively. The results were analyzed statistically compared with the other eye of patients.Results The patients with idiopathic macular hole suffered a significant reduction in BCVA, as well as mfERG P wave and N₁ amplitude in foveal and perifoveal area (P<0.05). Though the mfERG parameters gradually recovered after operation, can not reach healthy level. This study also observed that the mfERG P wave latency delayed at 3 months postoperatively and recovered at 6 months after surgery. Preoperative BCVA and dmin, dmax were significantly related (ρ=0.549, ρ=0.610, P<0.01),but had no correlation with the parameters of mfERG; postoperative BCVA and central retinal thickness(CRT) were related (P<0.05), and no relationship was found between postoperative BCVA and mfERG parameters.Conclusion The postoperative visual acuity and visual function of eyes with idiopathic macular hole improved. The macular structure and function had a certain degree of recovery. Preoperative and postoperative OCT of main indexes in patients with best corrected vision, preoperative dmin, dmax of patients visual acuity after predictive significance. This study did not find preoperative mfERG parameters on postoperative best corrected visual acuity has prognostic significance.

Progress in the molecular mechanism of optic nerve damage caused by stress in glaucoma

Yan Fancheng, Wang Ningli

2017, 38(1):  38-41.  doi:10.3969/j.issn.1006-7795.2017.01.008

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Glaucoma is a disease characterized by optic nerve damage, visual field defect, and retinal ganglion cells (RGCs) death,which is one of the most common irreversible blinding eye disease in the world. However, the mechanism of the optic nerve damage is not clear. By now, there are no effective clinical neuroprotective treatment methods, especially it was proposed that intervention mode through the RGCs confront against the stress-related damage through molecular methods should be developed. So to explore molecular mechanisms of stress-related damage, such as mechanosensitivity signaling pathways and inflammatory factors of retinal secondary damage mechanism, are becoming hot spots in this field of research. This article summarizes the research progress in the above mentioned fields.

Normobaric hyperoxia protect cerebral ischemia/reperfusion injured rats by downregulating voltage-dependent anion channel protein

Shi Wenjuan, Qi Zhifeng, Liu Kejian

2017, 38(1):  42-46.  doi:10.3969/j.issn.1006-7795.2017.01.009

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Objective To observe the effect of normobaric hyperoxia (NBO) on expression of voltage-dependent anion channel (VDAC), cytochrome C (CytC) and cleaved caspase-3 induced by cerebral ischemia-reperfusion injury in rats, and preliminarily explore the mechanism of NBO treatment on prevention of apoptosis. Methods Fifteen healthy adult male Sprague-Dawley (SD) rats (280-320 g) were divided randomly into three groups:Sham group (n=3), Normoxia group (n=6) and NBO group (n=6). A model operation of MCAO was performed using intraluminal suture method. The rats underwent MCAO for 1.5 h plus 24 h reperfusion. After model operation the rats of sham group and normoxia group breathed normal air, and instead NBO group rats breathed 100% oxygen until reperfusion. Western blotting was used to test the expression of VDAC, CytC and cleaved caspase-3 protein in ischemic penumbra region. Results Western blotting results showed that compared with the sham group, the VDAC protein expression of ischemic penumbra was increased (P<0.05) in the normoxia group, and compared with the normoxia group, the expression of VDAC protein in ischemic penumbra region was statistically significantly reduced (P<0.05) in NBO group. Compared with the normoxia group, the expressions of CytC protein and cleaved caspase-3 protein in ischemic penumbra region were statistically significantly decreased (P<0.05) in NBO group. Conclusion NBO treatment may inhibit cerebral ischemia-induced apoptosis by downregulating the excessive expression of voltage-dependent anion channel protein in ischemic penumbra region, thus to play a protective role in the ischemia/reperfusion injured brain.

Effects of chrysophanol on the expressions of cyclooxygenase-2 and matrix metalloproteinase-9 in the penumbra of mice following focal cerebral ischemia/reperfusion

Fang Yalan, Huang Yuyou, Zhao Yongmei, Li Jincheng, Duan Yunxia, Zhao Haiping, Gao Li, Luo Yumin

2017, 38(1):  47-52.  doi:10.3969/j.issn.1006-7795.2017.01.010

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Objective To explore the effects of Chrysophanol (CHR) on the expression levels of cyclooxygenase-2 (COX2) and matrix metalloproteinase-9 (MMP-9) in mice with middle cerebral artery occlusion (MCAO)/reperfusion injury and to investigate the potential anti-inflammatory mechanism of CHR. Methods Eighteen male C57BL mice were divided into 3 groups randomly:Sham group (n=6), MCAO group (n=6), and CHR group[mice received 0.1 mg/kg CHR (i.p.) for 14 days after ischemia/reperfusion]. MCAO was induced by using the suture method. The mice underwent 45 min of right MCAO, and then reperfusion by withdrawing filament. Rectal temperature was monitored and kept in normal range during the operation. The mice were sacrificed and the brains were harvested on 14 d after reperfusion. The expressions of COX2 and MMP-9 were detected by immunofluorescent staining. And the cellular location of COX2 and MMP-9 were detected by double immunofluorescence labeled antibody technique. Results 1) In Sham group, little COX2 positive cells and MMP-9 positive cells were observed. Compared with Sham group, the number of COX2 positive cells and MMP-9 positive cells increased significantly in the penumbra of MCAO group (P<0.05). 2) Compared with MCAO group, the number of COX2 positive cells and MMP-9 positive cells decreased significantly in the penumbra of MCAO+CHR group on day 14 after reperfusion (P<0.05). 3) COX2-positive immunoreactive cells were colocalized with the general neuronal marker, NeuN, in the penumbra of ischemia/reperfusion mice. And MMP-9-positive immunoreactive cells were colocalized with NeuN. Conclusion CHR has long-term neuroprotective effect against ischemia/reperfusion injury which might be attributed to its anti-inflammatory actions by decreasing the expression of COX2 and MMP-9.

Association between glucose parameters and outcome measures in acute ischemic stroke with intravenous thrombolytic treatment

Huang Qiang, Ma Qingfeng, Song Haiqing, Wu Jian

2017, 38(1):  53-58.  doi:10.3969/j.issn.1006-7795.2017.01.011

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Objective To investigate the association between glucose parameters and outcome measures in acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). Methods Two hundred and two eligible cases were enrolled in the cohort study. Blood glucose (BG), fasting BG and glycosylated hemoglobin A1c (HbA1c) determined on admission were taken as continuous variables, therapeutic outcome measures[e.g., modified Rankin Scale (mRS)≤2 at discharge, early neurological improvement (ENI) or deterioration (END), and recanalization status] and safety outcome measures[symptomatic intracranial hemorrhage (SICH) and all intracranial hemorrhage (ICH)] were taken as endpoint indicators. Results Of the recruited cases, the median age was 61 years, 25.2% female, median National Institute of Health Stoke Scale (NIHSS) 9 scores and onset to needle (OTN) time 230 min. The median fasting BGs were much lower in subgroups with favorable outcome (mRS≤2) or recanalization than those in the related reference subgroups, while the comparisons according to ICH and SICH didn't reach significance. Significantly higher admission BG was only found in the comparison according to SICH and the HbA1c levels were similar in all comparisons. Adjusted for age, sex, OTN and baseline NIHSS, admission BG[odds ratio (OR), 1.24; 95% confidence interval (CI):1.03-1.50] was the only independent predictor of SICH, while fasting BG was negatively associated with all therapeutic outcome measures, with an OR of 0.72 (0.58-0.90) for mRS≤2 at discharge, an OR of 0.69 (0.55-0.87) for ENI, and an OR of 0.80 (0.66-0.98) for recanalization. Elevated fasting BG was only significantly associated with Non-SICH related END (OR:1.42, 95%CI:1.04-1.95) after adjustment for explanatory variables.Conclusion Acute glucose parameters could be independent predictors of outcomes in AIS after IVT and elevated fasting BG negatively affected the functional outcome probably through the mechanism of an impaired response of IVT.

Study of ApoEε4 gene combined with sMRI in mild cognitive impairment

Ma Jun, Wang Zhaohui, Gu Xuesong, Man Fengyuan

2017, 38(1):  59-62.  doi:10.3969/j.issn.1006-7795.2017.01.012

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Objective To evaluate demographics, neuropsychological performance, structural magnetic resonance imaging (sMRI) measures, and apolipoprotein E genotype among four mild cognitive impairment (MCI) subtypes. Methods A total of 94 subjects with MCI and 53 cognitively normal older participants (controls) were evaluated. Classification of subjects with MCI into four subtypes based on neuropsychological performance, were investigated about sMRI research and ApoEε4 genotype. Medial temporal lobe atrophy (MTA) and prevalence of white matter hyperintensity (WMH) were assessed by sMRI. In addition, to study the relationship between Minimum Mental State Examination (MMSE) score, MTA score and ApoEε4 score, WMH and MCI subtypes. Results Severity of MMSE and MTA differed among MCI subtypes and control group. We found that 2 amnestic forms of MCI patients had significantly higher MTA scores than the 2 nonamnestic forms of MCI patients. However, there are not significant differences in WMH among the MCI subtypes. Apolipoprotein E genotype prevalence was significantly higher in the amnestic compared with nonamnestic subtypes of MCI. In addition, in amnestic MCI-single domain (aMCI-SD) and amnestic MCI-multiple domain (aMCI-MD) subjects, presence of ApoEε4 allele had a significant impact on the severity of MTA and memory deficits. Conclusion The different subtypes of MCI, may display biological heterogeneity, suggesting that sMRI in combination with the ApoEε4 genotype might be more helpful to predict progression from MCI to dementia.

Acupuncture in the treatment of central post-stroke pain: a randomized placebo-controlled trial

Wang Hao, Li Wei, Zhang Li, Yu Xiaogang

2017, 38(1):  63-66.  doi:10.3969/j.issn.1006-7795.2017.01.013

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Objective To observe the effects of the acupuncture on the central post-stroke pain (CPSP). Methods Seventy cases of CPSP were randomly divided into an acupuncture group (35 cases) and a medication group (35 cases). The basic treatment of cerebrovascular disease was applied in two groups. The acupuncture group was treated with acupuncture at Baihui (GV20) etc, five times every week, and totally 4 weeks were required, while the medication group was given Amitriptyline (25 mg each time,thrice a day), continuously for 28 days. The scores of Visual Analogue Scale/Score (VAS), short-form of McGill pain questionnaire (SF-MPQ) were evaluated in both groups. Results The total effective rate was 72.9%(23/32)in acupuncture group, which was better than 51.5%(17/33,P<0.05) in the medication group. The scores of VAS and SF-MPQ after treatment were decreased as compared with those before treatment in both groups (all P<0.05). In terms of sensory, emotion and pain,the acupuncture group was superior to the medication group (P<0.05). Conclusion Acupuncture could relieve pain in treating central post-stroke pain.

Role of nitric oxide and its derivatives in ischemic cerebrovascular disease

Huang Yuyou, Fang Yalan, Liu Kejian, Zhao Yongmei

2017, 38(1):  67-71.  doi:10.3969/j.issn.1006-7795.2017.01.014

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Ischemic stroke is the major cause of death and remains as one of the most common causes of disability worldwide. It is well known that cerebral ischemic injury enhances the formation of nitric oxide (NO). It is believed that excessive NO production plays an important role in the development of ischemic brain injury. NO probably contribute to ischemic injury by attacking macromolecules directly, including proteins and lipids, and disrupting mitochondrial function, or indirectly affecting cellular signaling pathways and gene regulation. Excessive production of NO may be neurotoxic, which leads to cascade reactions of excitotoxicity, inflammation and apoptosis. However, NO may also play a neuroprotective role in brain ischemia processes. In this paper, the role of NO and its derivatives in cerebral ischemic injury are reviewed.

“Dynamic spot sign” on computed tomography perfusion source images(CTP-SI) predicts hematoma expansion in acute intracerebral hemorrhage

Sun Shengjun, Han Liping, Su Yaping, Gao Peiyi

2017, 38(1):  72-77.  doi:10.3969/j.issn.1006-7795.2017.01.015

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Objective To evaluate the association between the presence of tiny dynamic progressive enhancing foci ("dynamic spot sign") in acute intracerebral hematoma on computed tomography perfusion source images (CTP-SI) and hematoma expansion. Methods Totally 121 consecutive patients with spontaneous intracerebral hemorrhage (ICH) by no-contrast-enhanced CT (NCCT), computed tomography perfusion(CTP) examination within 6 hours after symptom onset were included in this prospective study. Imaging data were evaluated by two experienced radiologists. Patients were dichotomized according to the presence or absence of the dynamic spot sign on CTP-SI in hematoma. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in univariate and multivariate regression analysis.Results Hematoma expansion occurred in 28 patients (25.0%) on follow-up. Thirty patients (26.8%) were demonstrated dynamic spot sign. On CTP-SI, about 25(83.3%) patients with hematoma expansion and 5 (16.7%) without demonstrated by the dynamic spot sign were pound. Sensitivity, specificity, positive predictive value, negative predictive value, and Kappa value for expansion were 89.3%, 94.0%, 83.3%, 96.3%, and Kappa is 0.814 (P<0.001), respectively. Interobserver agreement was high (κ=0.92). In multiple regression, the presence of CTP dynamic spot sign within acute hematomas independently predicted hematoma expansion, univariate analysis OR value was 131.667(29.386-590.289)(P<0.000 1). Moreover, multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123-1295.488)(P<0.000 1).Conclusion The computed tomography perfusion source images dynamic spot sign is associated with the presence and extent of hematoma expansion. CTP dynamic spot sign is more direct for showing active ongoing bleeding. It can be used as a guide for further strengthening the treatment and monitoring of patients with cerebral hemorrhage.

Application of laparoscopic common bile duct exploration with primary closure in treatment of choledocholithiasis in elderly patients

Liang Kuo, Liu Dongbin, Liu Jiafeng, Xu Dahua, Wang Yuehua, Li Fei

2017, 38(1):  78-81.  doi:10.3969/j.issn.1006-7795.2017.01.016

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Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) with primary closure for management of choledocholithiasis in elderly patients. Methods The clinical data of 63 elderly patients (≥65 years) with gallbladder stones complicated with choledocholithiasis who were undergone LCBDE and primary closure from July 2012 to July 2016 were retrospectively analyzed.Results LCBDE and primary closure of all the 63 cases were successfully completed. The operative time was 43-164 (79.8±20.5) min, the blood loss was 10-150 (24.4±21.1) mL, postoperative hospital stay was 3-15 (6.6±1.9) d.Six cases suffered from bile leakage and one of them received second operation. During the follow-up of 3 to 48 months, residual common bile duct stones presented in 1 case.Conclusion LCBDE with primary closure has the advantages of minimal invasion and rapid recovery. It is safe and feasible to treat the elderly patients with common bile duct stones under the premise of strict surgical indications, skilled laparoscopic procedures and accurate endoscopic suture techniques.

Clinical value of color photography combined indirect ophthalmoscope in HIV/AIDS ophthalmology screening

Dong Yu, Liu Yuehong, Xu Xuejing, Liu Binbin

2017, 38(1):  82-84.  doi:10.3969/j.issn.1006-7795.2017.01.017

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Objective To study the clinical value of color photography combined indirect ophthalmoscope in acquired immune deficiency syndrome (AIDS) ophthalmology screening. Methods Color fundus photography and indirect ophthalmoscope eye examination were done in the 110 AIDS patients from January 1, 2014 to June 23, 2014 in Beijing Ditan Hospital, Capital Medical University. Results Through clinical trials to draw color fundus we found that camera detection rate was 79%, system survival rate was 100%, indirect ophthalmoscope system detection rate was 95%, survival rate was 0%, joint inspection detection rate was 98%, system survival rate was 100%. Color fundus photography system can be archived, screening was not done to peripheral fundus lesions; indirect ophthalmoscope examination results can not be saved, to hide the phenomenon of peripheral fundus lesions screening. Conclusion Combined with indirect ophthalmoscope, fundus color photography and accurate screening for human immunodeficiency virus (HIV) retinopathy, examination results intact, provided valuable data for clinical teaching, scientific research, can effectively improve the diagnosis of AIDS fundus disease rate, AIDS patients with fundus disease which has important clinical value for early detection.

Analysis of laparoscopic sleeve gastrectomy for obesity

Xing Ying, Yan Wenmao, Qin Xiaoguang, Li Youguo, Xu Jun, Zhong Zhiqiang, Bai Rixing

2017, 38(1):  85-91.  doi:10.3969/j.issn.1006-7795.2017.01.018

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Objective To analyze the effect of laparoscopic sleeve gastrectomy on obesity and its co-related diseases. Methods Totally 26 patients with obesity were undergone laparoscopic sleeve gastrectomy at Beijing Tiantan Hospital, Capital Medical University from July 2012 to September 2015, weight body mass index(BMI) and biochemical indicators of per-operation and 3,6,12 and 18 post-operation was recorded. Results All cases were successfully completed in laparoscopic sleeve gastrectomy without conversion to laparotomy. Mean operative time was (79.7±4.7)min,50-170 min, with mean blood loss of (24.6±1.8)mL,10-50 mL, and mean postoperative hospital stay was (5.9±0.3)days,5-13 days. One seroperitoneum and 1 intra-abdominal hemorrhage occurred postoperative, all treated with expectant treatment. 3,6,12,18 months post-operation excess weight loss (EWL) was 54.9%,62.7%,80.1% and 68.4%. No uncontrolled malnutrition occurred during 3-36 month fellow-up. One gallstone(3.8%), 2 iron-deficiency anemia(7.6%) and 2 gastroesophageal reflux disease(7.6%) occurred the same time. Co-related diseases such as hypertension, fatty liver, hyperlipidemia, abnormal liver function, hyperuricemia were improved. Conclusion Laparoscopic sleeve gastrectomy is effective on weight control as well as on biochemical indicators and co-related diseases improve in obese patients. Further research is required to compare the effect of sleeve gastrectomy with gastric bypass and other bariatric surgeries.

Risk factor of second primary gynecological malignancy among women with breast cancer surgery

Liu Chen, Wu Long, Jiang Hongchuan, Li Jie, Liu Jun, Wang Shuzhen

2017, 38(1):  92-96.  doi:10.3969/j.issn.1006-7795.2017.01.019

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Objective To investigate the risk factor of second primary gynecological malignancy among women diagnosed with breast cancer.Methods In order to examine these factors in women with breast cancer who develop subsequentgynecological malignancy, a case-control study was performed. All the patients and control cases were enrolled from Beijing Chaoyang Hospital, Capital Medical University with the case vs control ratio of 1:4. Information concerning possible risk factors were extracted from hospital records and compared with matched controls. χ² and multivariate Logistic regression analysis were performed with SPSS18.0 statistical software for data statistics. Results Among the cases followed, 12 cases of ovarian cancer and 12 cases of endometrial cancer were diagnosed. Univariate analysis suggested that factors such as menarche early than 13 years (OR=6.5,95% CI:2.37-27.81), family history of cancer(OR=3.57,95% CI:1.27-10.06),family history of breast and/or gynecological cancer(OR=5.13,95% CI:1.47-17.92),diabetes mellitus(OR=2.12,95% CI:1.32-12.70) were possibly connected with a significantincreased risk of subsequent gynecological malignancy,while endocrine therapy(OR=0.29,95% CI:0.11-0.78), gynecologic examination termly(OR=0.33,95% CI:0.12-0.86) were significantdecreased risk of subsequent gynecological malignancy. Further multivariate Logistic regression analysis showed that heredity of breast and/or gynecological malignancy (P=0.003, OR=5.951), the early menarche age (P=0.000, OR=9.909), diabetes (P=0.010, OR=9.842) are risk factors of the breast cancer subsequent gynecological malignancy. Gynecological examination termly after breast cancer (P=0.037, OR=0.268) was a protective factor.Conclusion Patients of breast cancer with heredity for breast and/or gynecological cancer, early menarche age, suffered from diabetes have a higher risk of subsequent gynecological malignancy.It was recommended that breast cancer surveillance should including gynecologic examination termly which may be a protective factor from subsequent gynecological malignancy.

The change of prefrontal Oxy-Hb peak concentration and the time to peak in patients with different degree depression after stroke

Yang Zhiquan, Liu Aixian, Nie Yiqiu

2017, 38(1):  97-102.  doi:10.3969/j.issn.1006-7795.2017.01.020

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Objective To investigate the change of oxygenate hemoglobin(Oxy-Hb)peak concentration and the time to peak in prefrontal brain lobe in post stroke depression patients with different degrees and to move forward a single step for discussing whether can use functional near-infrared spectroscopy to assist in early diagnosis of depression after stroke.Methods Via functional near-infrared spectroscopy to test 93 patients with PSD (mild depression group 27 cases, moderate depression group 19 cases,major depression group 18 cases)and 29 controls. All subjects completed verbal fluency test in which they were asked to make words as many as possible according to one of three words. The peak level of Oxy-Hb and the time to peak was analyzed in patients with PSD and the control when they completed baseline and verbal fluency test. Results The peak level of Oxy-Hb was (0.29±0.17)mmol·L^-1·mm and the time to peak was (74.27±24.12) s in mild depression group patients with PSD. In moderate depression group,the peak level of Oxy-Hb was (0.17±0.11)mmol·L^-1·mm and the time to peak was (95.14±70.35)s. And in major depression group,the peak level of Oxy-Hb was (0.16±0.30)mmol·L^-1·mm and the time to peak was (125.95±25.68)s. The controls were (0.32±0.10)mmol·L^-1·mm and (69.23±41.78)s. The peak level and the time to peak in mild depression group had no statistically significant difference compared with the control group. Patients with moderate depression group and the control group were different significantly only in Oxy-Hb peak concentration. Only patients with major depression group and control group patients were statistically significant both in the peak level and the time to peak. Conclusion Oxy-Hb peak concentration is one of the more sensitive biological indexes which can be used for the observation of moderate and major patients with PSD. The time to peak applied only to patients with major depression. For patients with mild depression these two indexes were not applicable.

A clinical characteristic study of the patients with overt diabetes mellitus and gestational diabetes mellitus

Wang Rui, Xu Pinying, Xiao Li

2017, 38(1):  103-107.  doi:10.3969/j.issn.1006-7795.2017.01.021

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Objective To explore the clinical characteristics of patients with overt diabetes mellitus and gestational diabetes mellitus at the late pregnancy. Methods Twenty-five cases of pregnancy overt diabetes and 30 cases of gestational diabetes mellitus from January 2015 to February 2016 who came to the Clinical Nutrition Department of Beijing Anzhen Hospital were randomly selected. We collected records of patients with a family history, past medical history and other related medical conditions and treatment, clinical nutrition indexes, blood pressure measurement, serous hemoglobin A1c(HbA1c), total protein(TP), albumin(ALB), prealbumin(PALB), urea nitrogen(BUN), serum creatinine(CREA), hemoglobin(HGB). We gave them dynamic blood glucose monitoring and record the changes of blood glucose and the test data. We statistically analyze the data of two groups. Results In the ODM, HbA1c, fasting blood glucose, average blood glucose values,two-hour blood glucose after breakfast, two-hour blood glucose after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than that of GDM and two groups compared with statistical significance(P<0.05). It is recommended to use insulin patients in ODM accounted for 32%(8/25), significantly higher than GDM(0/30) (P<0.05). ODM has a family history of diabetes patients accounted for 48%(12/25),significantly higher than GDM 10%(3/30) (P<0.05). The urinary ketone positive rate in GDM was significantly higher than those in ODM(P<0.05), but urinary microalbumin abnormal rate was compared with no statistical difference (P>0.05). The number of preeclampsia in ODM(7/25) was significantly higher than that in GDM (P<0.05). The level of HGB in ODM was lower than that of GDM (P<0.05). Conclusion Late pregnancy ODM have obvious family history, high level of HbA1c, higher fasting glucose levels of breakfast, higher glucose levels of two-hour after breakfast and dinner,higher average blood glucose value, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher incidence of complications pregnancy complications than GDM, but HGB level is lower than GDM. GDM has higher positive rate of urine ketone than ODM.

Value of plasma NT-proBNP and total cholesterol levels of patients with heart valve disease predicting malignant arrhythmia

Li Chunzhi, Zhao Xin, Guo Shiqiang

2017, 38(1):  108-112.  doi:10.3969/j.issn.1006-7795.2017.01.022

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Objective To investigate the value of plasma N-terminal brain natriuretic peptide precursor (NT-proBNP) and total cholesterol (TC) levels of patients with heart valve disease predicting malignant arrhythmia(MA). Methods Totally 168 patients with heart valve disease were selected to constitute a research group, and other 30 healthy persons who had physical examination in the same period were selected to constitute a control group. Enzyme-linked immunosorbent (ELISA) was applied in detection of plasma NT-proBNP and TC levels of the control group and the research group preoperative (T₀), postoperative 1d (T₁), 3d (T₂), 1 week (T₃), and 1 month (T₄). The research group was followed up for two years and the occurrence of MA was statistically analyzed. The research groups were divided into MA group (n=18) and non-MA group(n=150) two subgroups according to the occurrence of MA. perioperative plasma NT-proBNP and TC levels of MA group and non-MA group were compared and receiver operating characteristic curve (ROC) was applied in analysis of value of plasma NT-proBNP and TC levels of patients with heart valve disease predicting the MA. Results Compared with control group, perioperative plasma NT-proBNP and TC levels of the research group were increased; compared with T₀, T₁, T₃ and T₄ plasma NT-proBNP and TC levels of the research group were lower (P<0.05). MA incidence of the research group was 10.71% (18/168), and perioperative plasma NT-proBNP and TC levels of MA group were higher than that of non-MA group (P<0.05). ROC curve analysis results showed that when the cutoff valued of plasma NT-proBNP and TC level were 728.28 pg/mL and 4.15 mmol/L, the AUC=0.884(95%CI:0.791-0.936), there was 17 patients with MA on the curve, thus the sensitivity was 94.44%, and there was 148 cases of patients without MA under the curve, thus the specificity was 98.67%, and the accuracy, positive predictive value and negative predictive value were 98.21%, 89.47% and 99.33% respectively. Value of plasma NT-proBNP and TC levels of patients with heart valve disease predicting MA was good. Conclusion Plasma NT-proBNP and TC levels of patients with heart valve disease were higher and the value of the two above items unitedly predicting MA is good. This may be associated with the NT-proBNP relating with cardiac function injury and TC regulating heart electrolyte balance effect, thus plasma NT-proBNP and TC levels of patients with heart valve disease could predict MA and thus to provide basis for improving outcomes.

Structure and feature of nano-medicines assembled by biodegradable polymers

Zhao Ming, Peng Shiqi

2017, 38(1):  126-142.  doi:10.3969/j.issn.1006-7795.2017.01.026

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Major progress in the understanding of the onset and pathology of a series of diseases highlights the biodegradable polymers based nano-medicine having desirable pharmaceutical and pharmacological property, targeting disease site, crossing biological barriers, exhibiting multiple functions and monitoring real-time drug-distribution. These advantages of nano-medicines attract a great deal of research interests, and the polymeric biodegradable conjugates have been deeply emphasized by medicinal chemistry in particular. In this regard, the present review focuses on the assembling process and feature of biodegradable polymers based nano-medicines. To get insight into the assembling process of the biodegradable polymers and to visualize the feature of the formed nano-species we provided a number of figures.