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The vascular endothelial growth factor (VEGF) level in human circulation may reflect the severity of endothelial dysfunction in patients with diabetes mellitus, which leads to diabetic microvascular complications. We determined plasma VEGF levels as well as metabolic control and inflammatory factors in 26 healthy subjects and 52 type-2 diabetes mellitus (T2DM) patients with or without diabetic microvascular complications. Pearson correlation coefficient was used to evaluate the associations among those indices. The results showed that VEGF levels in plasma were positively correlated with fasting blood glucose level, glycosylated hemoglobin (HbA1c) level, type 1 helper T cell (Th1) percentage, and Th1/Th2 ratio, while they were negatively correlated with regulatory T cell percentage. Multiple linear regression analysis showed that HbA1c and Th1/Th2 ratio were the independent predictors of VEGF levels in T2DM patients. Thus, in T2DM patients with poor glycemic control as well as an elevated Th1/Th2 cell ratio, more VEGF might be released.

Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method: Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. Results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II°-I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.

To investigate plasma gamma-glutamyl transpeptidase (γ-GGT) level as a cardiovascular risk factor in elderly patients with hypertension or hypertension with diabetes mellitus.Forty-nine elderly patients of hypertension and 42 elderly patients of hypertension with diabetes mellitus and 39 healthy elderly subjects were enrolled in the study. The height, weight and blood pressure of patients were measured, serum C reactive protein and other biochemical indicators were detected. The relation between plasma γ-GGT and cardiovascular risk factors in three groups were analyzed.There was no significant difference in plasma γ-GGT levels among three groups. There was a positive correlation of plasma γ-GGT levels with systolic pressure, pulse pressure, hemoglobin A1c and CRP in control group. While in hypertension with diabetes mellitus group, plasma γ-GGT levels were correlated with systolic pressure, mean arterial pressure, fasting blood sugar and cystatin.Plasma γ-GGT might be a risk factor for cardiovascular diseases, and may be used as a predictive indicator for kidney injury in early patients with hypertension with diabetes mellitus.

To establish an animal model of traumatic optic neuropathy (TON) that resemble to clinical state and study the mechanical principle and change of pathophysiology of its nerve injury for clinical diagnosis and treatment.New Zealand white rabbits were used as the research objects. The method introduced by Wang Yi was repeated and improved. Mild and severe animal models of TON were established by reformed Wang Yi operation separately. After the spring gun struck, all animals were observed on pupils and direct light reflex and received the examinations of pattern reversal visual evoked potentials (PR-VEP). The pathophysiology of normal and injury optic nerve was observed.After recovery from anesthesia, the mydriasis and disappearance or dullness of direct light reflex happened in all injured eyes. No brain contusion, infection, orbital fracture and death were found. One optic nerve was broken with complete tunica vaginalis. The latency and amplitude of injured eyes deteriorated gradually. In group B, the waves became flat rapidly. After injury, the optic nerve underwent 3 stages: edema, hyperplasia and atrophy. The pathomorphological changes of injured eyes in group B were more serious than that in group A in any time.The reformed operation can establish constant nerve injury with high success rate. In mildly injured eyes, the injury deteriorated gradually. However, part visual function remained. In severely injured eyes, the pathomorphological changes were irreversible sooner after struck, and the visual function lost completely. There is a good correlation between PR-VEP and pathomorphology. PR-VEP can guide the clinical diagnosis and treatment.

To evaluate the therapeutic efficacy of combined treatment with surgical decompression and drug for traumatic optic neuropathy (TON) and analyze the influential factors.A retrospective study on 69 patients (70 eyes) with TON treated with optic canal decompression through transnasal endoscopic approach and drug was conducted. The visual acuity was divided into 5 grades: no light perception (NLP), light perception (LP), hand move, count finger,0.02, marked as I-V respectively. Of 40 eyes with grade I, 18 eyes received emergency operation for severe optic canal fracture confirmed by CT; 22 eyes received corticosteroid therapy firstly and then operation. Of 30 eyes above grade I, 16 eyes with optic canal fracture confirmed by CT received emergency operation; 14 eyes received corticosteroid therapy firstly and 3 days later received operation. Postoperative follow-up lasted 3-12 months to observe the recovery of visual acuity.The therapeutic efficacy of patients with the visual acuity of LP and above LP was better than that of NLP (90.0% to 27.5%), the difference had statistical significance (chi(2) = 26.98, P0.001). In operated group, the therapeutic efficacy in patients whose visual acuity was improved from NLP after glucocorticoid therapy (80.0%) was better than that of the patients with no improvement (5.9%), the difference had statistical significance (chi(2) = 12.09, P0.001).The imaging findings of optic canal fracture can not be used as determinants for operation. The patients with NLP whose visual acuity had no improvement after corticosteroid therapy are poor candidates for surgical decompression. The visual acuity before treatment is the main factor affecting the therapeutic efficacy.

To explore the diagnosis and treatment of delayed traumatic epistaxis and put forward a concept of arteriola pseudoaneurysmal epistaxis originated from maxillofacial medium-sized artery.The clinical data of 53 patients who had the typical symptoms of delayed traumatic epistaxis and received digital subtraction angiography examination and treated in recent 10 years were retrospectively analyzed.Among the 53 patients, 8 patients suffered from interval carotid artery pseudoaneurysm. For these 8 patients, 1 died of massive epistaxis before embolization, 7 received transcatheter arterial embolization( 6 cured and 1 died). Twenty patients suffered from traumatic carotid cavernous fistula, all were cured with endovascular occlusion by detachable balloon. Twenty-five patients suffered from maxillofacial artery hemorrhage. For these 25 patients, 21 were treated by transcatheter arterial embolization with gelatin sponge and coils, 4 by anterior ethmoidal artery ligation. The followed-up ranged from 6-72 months (median 5 years). All patients were successfully treated without serious complications and recurrent hemorrhage, except one patient who had recurred hemorrhage three weeks after transcatheter arterial embolization. This patient was again successfully treated by artery ligation.Interval carotid artery pseudoaneurysm, carotid cavernous fistula and maxillofacial medium-sized artery and arteriola pseudoaneurysm are the main causes of delayed traumatogenic epistaxis. Early diagnosis by digital subtraction angiography examination and transcatheter arterial embolization or artery ligation are the useful methods to treat delayed traumatic epistaxis and pseudoaneurysm.

To summarize the clinical experience in diagnosing and managing cerebrospinal fluid (CSF) rhinorrhea via transnasal endoscopic approach and its combination with frontal approach.A retrospective study of 58 patients with CSF rhinorrhea was conducted. Fifty eight cases were all under CT. Fifty six cases underwent surgical treatment Among them, 45 patients were treated with transnasal endoscopic approach, 11 whose cerebrospinal fistulas located in back wall of frontal sinus and orbital-frontal part with fronto-rhinal approach. Two were without any surgical treatment. Among 56 cases who underwent surgical treatment, 31 cases were under normal CT, of which 25 were accurate. Another 25 cases were under thin-section spiral CT scan and three-dimensional reconstruction, of which 23 were accurate. Eight cases locating the fistulas inaccurately by CT found the fistulas by operation.Postoperative follow-up lasted from 6 months to 5 years, a median follow-up period of 3 years. Among 45 cases with transnasal endoscopic approach, 43 were cured after the first attempt, one was cured after the second attempt; one died because of the intracranial infection. Among 11 cases with fronto-rhinal reossification, 10 were cured after the first attempt, one with orbital-frontal absence after the fifth attempt. Two left hospital and lost following-up without any surgical treatment.Thin-section spiral CT scan and three-dimensional reconstruction make the leak locating more accurate. Combination of frontal approach may deal with transnasal endoscopic surgery's demerit to the unreachable site and enhance the achievement ratio of the first attempt.

To investigate the classification, incidence and influential factors of severe complications occurred in endoscopic sinus surgery (ESS) and how to deal with them.One thousand and one hundred two patients with chronic sinusitis and nasal polyps treated by ESS were analyzed.Twenty-one patients had severe complications. The types of complication included intraorbital hematoma (n=3), medial rectus injury (n=2), blindness (n=1), intracranial, hematoma (n=1), cerebrospinal rhinorrhea (n=3), nasolacrimal duct injury (n=3), nasal septum perforation (n=2), hemorrhage (n=2), thrombosis in legs (n=2) and asthma (n=2). The total incidence of severe complications was 1.91% (21/1102), most of which were complications in orbit (0.54%) and cranium (0.36%). The extent of the lesion, the surgical history of the patients, the technique and experience of the surgeons were the most important influential factors to severe complications.Although there are many influential factors to severe complications in ESS, subjective factors are the more important, especial, the technique and the experience of the surgeon.