Thyroid eye disease in Asians and recent advances in management / 中华内分泌代谢杂志

This paper aims to review the current understanding and advances in knowledge of thyroid eye disease(TED)with a focus on Asian population. TED can significantly impact quality of life, and has devastating consequences, including facial disfigurement and vision loss. Recent findings revealed a novel targeted therapy against TED, including teprotumumab, a human monoclonal antibody that inhibits the insulin-like growth factor-1 receptor. Teprotumumab was found to reverse the disease process in patients with active, moderate-to-severe TED. A randomized clinical trial of this drug compared to placebo showed significant improvement in clinical activity score, proptosis, subjective diplopia, and quality of life at 4 months follow-up in the treatment group. In this paper, we review the current epidemiology, pathophysiology, and advances in management of TED.

The effect of early sequential enteral nutrition on postoperative rehabilitation in patients with gastric cancer / 肠外与肠内营养

Objective:Our study was aimed to analyze the therapeutic effect of early sequential enteral nutrition on postoperative rehabilitation in patients with gastric cancer.Methods:Patients with gastric cancer receiving surgery at our hospital from 2016 to 2017 included and the clinical information was prospective collected and analyzed.Patients were randomly divided into two groups using random number table.Patients in group A were sequentially given amino acid type,short peptide type and then whole protein type,while those in group B received whole protein formulation only.The recovery of gastrointestinal function,postoperative systemic inflammatory response,six-minutes walking test,and enteral nutrition-related complications were compared between the two groups.Results:A total of 71 patients were included in this study (Group A 36 cases,Group B 35 cases).There was no significant difference in terms of the restart anal exhaust between the two groups (P ＞ 0.05).Patients in group A had a significantly shorter postoperative hospitalization (t =4.070;P ＜ 0.01) and the earlier restoration of oral intake than that of Group B (t =3.400;P =0.001).One week after surgery,the levels of CRP (t =2.547;P =0.013) and IL-6 (t =3.172;P =0.002) were significant lower in group A when compared with group B.In addition,patients in group A had a significant higher six minutes walk steps than those in Group B [(416.1 + 36.7) m vs (358.9 ± 32.7) m;t =6.927,P ＜ 0.01].However,no significant difference in enteral nutrition-related complications was found between the two groups (P ＞ 0.05).Conclusion:In patients with gastric cancer,early sequential enteral nutrition can effectively accelerate the postoperative rehabilitation.

Application of elastic intramedullary nail in the treatment of primary aneurysmal bone cyst of extremities / 中华骨科杂志

Objective To compare the treatment effect and study the efficacy of the elastic intramedullary nails for the treatment of primary aneurysmal bone cysts in limbs.Methods Twenty one children with primary aneurysmal bone cystsadmitted to and treated in Shanghai Children's Hospital from 2012 January to 2016 June were studied retrospectively.There were 18 males and 3 females,with overall age of 1-14 years old and median age of 5 years old.The lesions were mainly located in the femur,tibia,fibula and humerus.They were divided into 2 groups according to the treatment plan.The patients of the experimentgroup received curettage and bone grafts with high-speed burring and elastic intramedullary nail.The patients of the control group received curettage and bone grafts with high-speed burring.According to the imaging results (Neer grading) and MSTS functional evaluation,the curative effect of the children of the 2 groups were analyzed statistically.Results The cure children were followed up for more than 2 yearswith follow-up time range of 24-48 months (mean value of 32.29±8.22 months).Five patients had a recurrence,with mean postoperative recurrence time of 10±2.66 months.A total of 5 patients of the control group perceived curettage and bone grafts with high-speed burring and a total of 16 patients of the experimentgroup received curettage and bone grafts with high-speed burring andelastic intramedullary nail.According to the imaging results (Neer grading) and MSTS function evaluation,Neer grading was 3 cases for grade Ⅰ,0 case for grade Ⅱ,1 case for grade Ⅲ and 12 cases for grade Ⅳ in the experiment groups.That was 1 case for grade Ⅰ,1 case for grade Ⅱ,2 cases for grade Ⅲ and 1 case for grade Ⅳ in the control group.The ABC recurrence rate of experimental group (18.8％) was lower than matched group (40％),while there was no significant difference.We found that MSTS functional scores of experimental group was significantly higher than the matched group (28.88±2.22 vs 20.80± 10.38,t=3.058,P=0.006).According to postoperative MSTS functional evaluation,we found that even the patients in the study group with recurrencewere also able to participate in physical exercises,without further occurrence of pathological fracture and the postoperative life quality was greatly improved.Conclusion Curettage and bone grafts with high-speed burring andelastic intramedullary nail can significantly reduce the recurrence rate of primary aneurysmal bone cysts in the four limbs.Meanwhile the MSTS function evaluation of the recurrence cases in this group all achieve to a satisfactory level.The reason of recurrence may be correlated to patient age and the distance between the focus and epiphyseal plate.Therefore,an appropriate treatment protocol is helpful in reducing the relapse rate and improving the patients' postoperative living quality.

Approach to the patients with Graves'ophthalmopathy / 中华内分泌代谢杂志

[Summary] Graves'ophthalmopathy ( GO) is the most common extrathyroidal manifestation of Graves disease ( GD) . It is an organ-specific autoimmune disorder. The estimated incidence of GO in the general population is 16 women and 3 men per 100,000 population every year. Approximately 3%-5% of patients with GO are exposed to the potential of losing their sight and requiring optimized medical intervention. For the clinicians it is helpful to assess the degree of activity and severity of GO;both are important in deciding whether a patient requires intervention and which type of intervention is indicated. These interventions include management of hyperthyroidism, measures to relieve local symptoms, immunosuppressive therapies for active moderate and severe GO, and finally rehabilitative surgery for inactive patients.

Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents / 中华实用儿科临床杂志

Objective To explore the clinical curative effect of hollow screw internal fixation for the treatment of distal epiphyseal teenagers tibial fracture.Methods Thirty -nine cases of epiphyseal fractures of the distal tibia were treated in Shanghai Children′s Hospital between February 2005 and September 201 4.This study included 24 boys and 1 5 girls with the average age of 1 3.1 years (ranged 1 0.5 to 1 6.2 years old).Preoperative diagnosis was confirmed by the X -ray films or CT examination.All the cases were closed fractures and manipulative reduction all failed.Surgi-cal reduction was performed when plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm or after closed reduction.Under C -arm X -ray machine,ankle axial traction was performed initially.Anatomical reduction underwent according to the bone fracture type.The fractures were fixed with cannulated screws by percutaneous or open approach.Postoperative X -ray or CT confirmed anatomical reduction at articular sur-face and growth plate.All patients had been immobilized with short -leg cast for 4 -6 weeks.The ankle joint function and growth were evaluated by means of American Orthopaedic Foot and Ankle Society(AOFAS)Ankle Hindfoot Scale. Results All patients were followed up for 5 to 91 months with an average duration of 35 months.X -ray films showed that all fractures were bone healing.No uneven articular surface was found and there was no extremity rotation and shorte-ning deformity.Results were evaluated by AOFAS scoring system:excellent in 27 cases,good in 10 cases,and general in 2 cases.All patients were able to participate in the normal physical activities.Conclusions CT with multiplanar recon-struction is a premise to make an accurate diagnosis and to choose a reasonable approach.For failed closed reduction for adolescent distal tibial epiphyseal fractures,the cannulated screws are simple and may have a satisfactory effect.

Clinical observation of combined Chinese and Western medicines in treatment of senile functional constipation / 中草药

Objective: To observe the efficacy of combined Chinese and Western medicines in the treatment of senile functional constipation. Methods: One hundred patients with senile functional constipation were divided into treatment group and control group. There were 50 in each group. The patients in the treatment group were treated with Danggui Shaoyao Decoction and Cisapride Tablets, while the patients in the control group were treated with Cisapride Tablets only. The efficacy in the two groups were compared after three courses. Results: The total effective rate of the treatment group was 92% and the control group's was 78%, the former was higher than latter with the comparatively significant difference (P < 0.05). Conclusion: The results indicate that the combination of Chinese and Western medicines is highly effective in the treatment of senile functional constipation.

Practice and thinking of standardized training for ophthalmology residents / 中华医学教育探索杂志

As one of the first resident standardized training bases, department of ophthalmology of Shanghai Ruijin Hospital participated in this reform process from 2010. Relevant rules and regulations (training management system , training scheme implementation system and evaluation system ) were strictly obeyed. When new problems emerged, under the guidance of department in charge, a series of regimens were formulated and improved gradually by Ophthalmology Professional Committee of Shanghai Resident Standardized Training Department. Based on reviewing and summarizing the work in the last 3 years, some thoughts and suggestions on the resident standardized training in future were put forward ,in-cluding how to better solve the“heavily used, lightly cultured” problem, the“disregarding medical ethics establishment”problem, the“disregarding assessment of teachers”problem and the“disregard-ing obtaining employment”problem.

Application of elastic stable intramedullary nailing for treating forearm fractures in children / 中华实用儿科临床杂志

Objective To summarize the application of elastic stable intramedullary nailing for treating forearm fractures in children and to evaluate its therapeutic effect.Methods A total of 98 cases of forearm fractures in children treated by elastic stable intramedullary nailing were analyzed,retrospectively.Eighty-seven cases were postoperatively followed up,but 11 cases were lost.Fifty-nine cases were male,39 cases were female,ageing from 3 to 16 yearold,and the mean age was 6.5 year-old.Sixty-seven cases were ulnar shaft fracture,23 cases were radial neck fractures and 8 cases were Monteggia fracture.Results Patients were followed up 4 to 36 months.Eighty-seven cases successfully achieved complete healing.Patients recovered with no pain,no deformity and obtained excellent functional recovery.One case achieved delayed healing,and skin irritation was found in 8 cases.Conclusions Elastic stable intramedullary nailing is a minimally invasive,approch easy to deal with soft tissue injury,quick in recovery,and has a good curative effect and fewer complications.Rationally using elastic stable intramedullary nailing for treating forearm fractures in children can achieve satisfactory postoperative outcomes.

Mitochondrial network in the heart

Mitochondria are subcellular organelles that provide energy for the cell. They form a dynamic tubular network and play an important role in maintaining the cell function and integrity. Heart is a powerful organ that supplies the motivation for circulation, thereby requiring large amounts of energy. Thus, the healthiness of cardiomyocytes and mitochondria is necessary for the normal cardiac function. Mitochondria not only lie in the center of the cell apoptotic pathway, but also are the major source of reactive oxygen species (ROS) generation. Mitochondrial morphological change includes fission and fusion that are regulated by a large number of proteins. In this review we discuss the regulators of mitochondrial fission/fusion and their association with cell apoptosis, autophagy and ROS production in the heart.

Endoscopic orbital decompression for thyroid-associated ophthalmopathy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the therapeutic results of endoscopic orbital decompression for thyroid-associated ophthalmopathy.@*METHOD@#The records of nine patients (twelve orbits) received endoscopic orbital decompression for thyroid-associated ophthalmopathy were analyzed for changes in visual acuity, intraocular pressure, proptosis, corneal ulceration and movement. The follow-ups ranged from two months to thirty-six months.@*RESULT@#Twelve orbits (100%) had improvement in visual acuity (range 0.1-0.7). Ten orbits (83.3%) decreased in intraocular pressure (range 0.2-21.4 mm Hg). Eight orbits (66.70%) decreased in proptosis (one-five mm). The orbit with corneal ulcer was healed after decompression. Diplopia was cured in one of four patients.@*CONCLUSION@#Endoscopic orbital decompression is a safe and effective procedure for the treatment of thyroid-associated ophthalmopathy.

Effect of pigment epithelium-derived factor on rat retinal Müller cells under high glucose conditions / 中华内分泌代谢杂志

Objective To investigate the effect of pigment epithelium-derived factor (PEDF) on rat retinal Müller cells under high glucose conditions. Methods Müller cells cultured in 25 mmoL/L glncose were incubated with 100 ng/ml PEDF or 10 ng/ml interleukin-1β(IL-1β) for 24 h. The expression of IL-1β or PEDF in Müller cells was measured by indirect immunofluorescence, Western blot or realtime RT-PCR. The survival of Müller cells was detected by MTT assay. Results Under high glucose conditions, expression of IL-1β or PEDF was decreased after treated with 100 ng/ml PEDF or 10 ng/ml IL-1β for 24 hours by the methods of immunocytochemistry, Western blot or realtime PCR (P ＜ 0.05). Activity of Müller cells was increased significantly by PEDF (0.48±0.09 vs 0.64±0.17, P＜0.05). Conclusion In mimic diabetic conditions, PEDF decreases expression of IL-1β in rat retinal Müller cells and enhances the cell activity. To some degree, PEDF may block the process of inflammation in diabetic retinopathy.