Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities.

There are various modes of American pre-hospital emergency with different rescue levels which can meet the needs of out-of-hospital rescue in different environments and grades. Pre-hospital emergency workers are relatively divided into different levels with different requirements of skills and practicing certificates. These sources and training of pre-hospital emergency workers of different levels are independent, totally different from those of medical workers in the hospital. By participating and watching the process of American pre-hospital emergency on the spot, observing and experiencing the classification and education levels of American pre-hospital emergency, analyzing the system of American pre-hospital emergency and their requirements for pre-hospital emergency workers' skills, and comparing with the actual situation of Chinese medicine education, the study showed the training differences between American pre-hospital emergency workers and Chinese pre-hospital emergency workers and their advantages in the hope of enhancing the pertinence of training Chinese pre-hospital emergency workers and providing a new direction for the development of Chinese pre-hospital emergency system from another view.

Objective: To investigate the postoperative inflammatory reaction, stress reaction and immune response of laparoscopic surgery and laparotomy for acute gastric perforation. Methods: Forty-four patients with acute gastric perforation receiving emergency surgery in our hospital from May 2012 to December 2015 were selected and retrospectively analyzed. Among these patients, there were 19 patients treated with laparoscopic surgery (LS group) and 25 patients treated with laparotomy (laparotomy group). At the first day after surgery, their serums were collected and the indexes of inflammatory reaction and stress reaction were detected. Mononuclear cells and red blood cells in peripheral blood were collected and detected for the immune function indexes. Results: At day 1 after surgery, the contents of serum interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, cortisol, norepinephrine, epinephrine, renin and angiotensin-II of patients in the LS group were all significantly lower than those of the laparotomy group; fluorescence intensities of CD3, CD4, CD16 and CD56 of mononuclear cells in peripheral blood were all obviously higher than those of the laparotomy group; and the numbers of red blood cell C3bR and immune complex resette and the fluorescence intensities of complement receptor type 3, CD58 and CD59 were obviously higher than those of the laparotomy group. Conclusions: Emergency laparoscopic surgery used to treat acute gastric perforation shows slight postoperative inflammatory reaction and stress reaction and presents weak nonspecific immune response, specific immune response and erythrocyte immune response, which makes less trauma than laparotomy.

Objective: To evaluate the gastro-protective effect of the aqueous, methanol and hexane root extracts of Ziziphus abyssinica on ethanol induced gastric ulcer in Wistar rats as models. Methods: Seventy rats were divided into seven groups of ten rats each: control group, ulcer control group, standard control group (cimetidine 100 mg/kg body weight), aqueous, methanol, ethyl acetate and hexane extract groups. They were administered the extracts at 300 and 600 mg/kg for two weeks before ulcer was induced, and the protective effect of all extracts determined. Results: Histological changes in gastric tissue were evaluated. Pretreatment with Ziziphus abyssinica extracts showed significant (P < 0.05) gastro-protective effect with aqueous extract having the highest gastro-protective effect (95% and 93% at 300 and 600 mg/kg extract respectively). Methanol extract had 66.6% and 65.5% protection at 300 and 600 mg/ kg respectively. The percentage protection in ethyl acetate extract treated group was 51% and 45% respectively. The group treated with hexane had 23.8% and 28.6% protection at 300 and 600 mg/kg, respectively. Histological study showed that pretreatment with aqueous extract resulted in the preservation of the functional cyto-architecture of the entire mucosa with little pathological changes, compared to other extracts. Conclusions: The results of this study indicated that aqueous extract is effective against induced gastric ulcer.

Objective: To investigate the effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction. Methods: A total of 74 patients with acute cerebral infarction treated in our hospital from March 2014 to December 2015 were retrospectively analyzed, and they were divided into ginkgo-damole group and conventional treatment group according to a therapeutic schedule that whether ginkgo-diyidamolum were included. At Week 2 and Week 4 after treatment, contents of apoptosis molecule, nerve injury molecule and index of platelet aggregation in serum were detected. Results: At Week 2 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients' sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. At Week 4 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients' sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. Conclusions: Adjuvant therapy with ginkgo-damole can inhibit the apoptosis of neuron cells and neurogliocyte and reduce the neural function injury and the situation of platelet aggregation.

Objective: To determine the general characteristics of urogenital trauma, and the factors that impact on mortality. Methods: Patients who were over 18 years of age admitted to the emergency service with urogenital injury between 1 January 2010 and 31 December 2014 were evaluated retrospectively. Age, gender, type of trauma, injured urogenital organs, vital parameters, additional organ injuries and mortality rate were investigated. Categorical variables were compared by using Chi-square test and comparing to groups data were performed with the Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. Results: The median age of 174 patients was 35 years (interquartile range: 22), and 150 patients (86.2%) were males. It was determined that the incidence of urogenital trauma increased in August and September. The kidney was the most frequently injured organ (41.4%) and the most common cause of injury was traffic accidents (49.4%). Mean arterial pressure and revised trauma score were the lowest while pulse rate was the highest in renal trauma patients (P < 0.05). Mean arterial pressure, revised trauma score and respiratory rate were low in mortal group while pulse rate and Glasgow coma scale scores were significantly higher (P < 0.05). Conclusions: It is determined that the most common injured organs in trauma patients are kidneys and bladder and also no single factor is effective on mortality.

Objective: To study the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction before and after the intervention of rosuvastatin and its correlation with toll-like receptor 2 (TLR2) and TLR4 signaling pathways. Methods: A total of 65 patients with acute cerebral infarction treated in our hospital from December 2015 to August 2016 were selected for prospective study. They were treated with lipid-lowering rosuvastatin, and peripheral blood samples were collected at 8th week before and after treatment, respectively. Serum was separated and expression quantity of miR-146a and miR-146b and contents of TNF-α, interleukin (IL)-1β, IL-6 and IL-17 were determined. Peripheral blood mononuclear cells were isolated and fluorescence intensities of TLR2, TLR4, myeloid differentiation primary response gene 88 (MyD88), interleukin-1 receptor-associated kinase 1 (IRAK-1) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) were measured. Results: At 8th week of intervention of rosuvastatin, expression quantity of serum miR-146a [(0.762 ± 0.092) vs. (0.346 ± 0.053)] and miR-146b [(0.714 ± 0.088) vs. (0.317 ± 0.047)] in patients with acute cerebral infarction was significantly higher than those before the intervention. Fluorescence intensities of peripheral blood mononuclear cells such as TLR2 [(10.34 ± 1.27) vs. (16.94 ± 1.94)], TLR4 [(11.37 ± 1.54) vs. (24.35 ± 3.26)], IRAK [(9.34 ± 0.92) vs. (15.32 ± 1.82)], MyD88 [(4.42 ± 0.56) vs. (9.41 ± 1.03)] and NF-kB [(6.65 ± 0.78) vs. (13.49 ± 1.76)] and contents of inflammatory factors such as TNF-α [(64.26 ± 8.29) μg/L vs. (106.39 ± 13.84) μg/L], IL-1β [(37.91 ± 5.24) μg/L vs. (64.23 ± 8.33) μg/L], IL-6 [(34.28 ± 4.85) ng/L vs. (82.46 ± 11.97) ng/L] and IL-17 [(56.75 ± 7.49) ng/L vs. (98.31 ± 11.36) ng/ L] of serum were all significantly lower than those before the intervention. Expression quantity of serum miR-146a and miR-146b had a negative correlation with fluorescence intensities of TLR2, TLR4, IRAK, MyD88 and NF-kB. Fluorescence intensities of TLR2 and TLR4 in peripheral blood mononuclear cells had a positive correlation with contents of TNF-α, IL-1β, IL-6 and IL-17 in serum. Conclusions: Treatment with rosuvastatin can up-regulate the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction and further inhibit the secretion of IRAK, MyD88, NF-kB, TNF-α, IL-1β, IL-6 and IL-17 mediated by TLR2 and TLR4.

Objective: To investigate the anti-inflammatory and antinociceptive effects of total alkaloids extracted from the leaf of Tamarindus indica (T. indica) in rats. Methods: Acetic acid-induced pain and egg albumin-induced inflammation were used to inspect the anti-nociceptive and anti-inflammatory effects of the crude and alkaloidal extracts of T. indica at doses of 40 and 400 mg/kg, respectively. Sodium diclofenac was used as the control drug. Results: The percentage yields of crude methanol and alkaloidal extracts of T. indica were 2.85% and 0.98%, respectively. Screening of secondary metabolite of the crude extract revealed the presence of saponins, alkaloids, tannins, steroids, phenols and terpenes, while phlobatannins was not detected. The safe dose and LD₅₀ were 400 and 750 mg/kg for crude methanol extract, respectively, while the safe dose and LD₅₀ of alkaloidal extract were 40 and 57 mg/kg, respectively. The anti-inflammatory and antinociceptive effects of crude methanol extract and alkaloid extract of T. indica were significantly (P < 0.05) different from those of control rats. The standard drug (sodium diclofenac), crude extract and alkaloidal extract showed percentage inhibition of 89.36%, 53.92% and 81.37% in paw edema, respectively. Conclusions: The results obtained indicated that the crude and alkaloidal extracts of the plant exhibited significant anti-inflammatory and antinociceptive activities, thus, supporting its folkloric use for the treatment of these conditions.

We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury. In addition, he sustained full-thickness burns of the right upper limb (7%), the right hemithorax, the perineum (sparing the penis), the anterior abdominal wall and the lateral aspect of both thighs. There was 43% burned surface area in total. Radiographic examination revealed a slender curved object extending from his perineum into the pelvis. The management of this case was a challenging one which was described in this article.

An important problem in management of the case with myasthenia gravis (MG) is the control of exacerbation. There are several possible causes of exacerbation of MG including the use of drug. Here, the authors report a case of MG exacerbation and diarrhea associated with erythromycin treatment.

Cyanide is a toxin and one of the most rapidly acting fatal poisons that human being is aware. If it is not treated promptly, encountering to cyanide poison will lead to die in minutes. Cyanide avoids cellular oxygen usage by inactivating mitochondrial cytochrome oxidase thus inhibits cellular respiration. In this case, we represent a case report describing uncommon cyanide intoxication owing to consumption of a few portion of apricot kernels and its rapid treatment with dicobalt edetate after suspection of cyanide poisoning.

Guillain-Barré syndrome is a complicated degenerative neurological disorder which can be either acute or chronic in nature. Guillain-Barré syndrome is an acquired condition and is characterized by progressive, symmetrical, proximal and distal tingling and weakness. Muscle stretch reflexes are decreased to absent and loss of sensation is common. A 4-year female child with no significant past medical history who presented with progressive weakness involving both upper and lower limbs over 48 to 72 h and complaints of tachypnea and hypotonia involving all group of muscles was admitted in Sri Venkateswara Ramnarayan Ruia Government General Hospital, Tirupati. In the present report, the main clinical aspects and features of Guillain-Barré syndrome along with the multidisciplinary approach to the acute phase combining supportive and high dose of immunoglobulin therapy were practiced. Patient should have follow-up within 2 weeks after the acute syndrome to evaluate for relapse, at which point repeat intravenous immunoglobulin. Thereafter, follow-up is necessary for every 4–6 weeks for 6 months, then 6 months for 1 year and then yearly.