Volume 90  ·   Issue 07  ·  2010

Refractive error, including myopia, hyperopia and astigmatism, is one of the main problems affecting human vision. Refractive surgery, as a mature and reliable refractive correction method in clinical practice, has been widely popularized. Refractive surgery, as an irreversible refractive error correction method, has been continuously mentioned and studied in the process of evaluating its correction effect, and has been applied in clinical practice.

Refractive error is one of the most common eye diseases in ophthalmology. At present, most adult refractive error is willing to undergo corneal refractive surgery worldwide, including excimer laser photorefractive keratectomy (PRK), excimer laser in situ Keratomileusis (LASIK) and Wavefront guided-LASIK, Topography guided LASIK, chemical subepithelial Keratomileusis (LASEK), mechanical subepithelial Keratomileusis (EpiLASIK), Q-adjusted LASIK, Sub-Bowman's Keratomileusis (SBK), femotosecond-assisted LASIK, etc.

Objective To evaluate visual quality of patients implanted with the AcrySof IQ ReSTOR~(R) muhifocal aspheric intraocular lens.Method Retrospective study of patients who had implantation of an AcrySof IQ ReSTOR SN6AD3 IOL(Group test)or an AcrySof ReSTOR SN60D3 IOL(Group control).Group test comprised 30 patients(35 eyes)and Group control,40 patients(56 eyes).Three months postoperatively,uncorrected and best corrected distance visual acuity,uncorrected and best corrected near visual acuity,best corrected intermediate visual acuity,the focus depth,higher order aberration,contrast sensitivity and glare sensitivity were measured in both IOL groups.Patients were orally administered a visual function questionnaire including questions about glare,halos,and other visual discomfort.Results The percentage of patients with uncorrected near,far and intermediate visual acuity ≥0.5 in test group was 80% (20/35),82.9%(29/35)and 45.7%(16/35)respectively,and that of the control group was 76.8%(43/56),80.4%(45/56)and 39.3%(22/56)respectively.There was no statistical difference of uncorrected visual acuity between two groups(P ＞ 0.05).When compare the best distance corrected near,far and intermediate visual acuity between two groups,we can get the same results(P ＞ 0.05).The contrast sensitivity and glare sensitivity in all frequency sect of group test have been more obviously improved postoperatively than that of group control(P ＜0.05).The Z(4,0),Z(4,2),S3+S4 and total S of Zemike coefficients was statistically different(P ＜0.05).The other Zemike coefficients and higher order aberration did not differ significantly between the two groups(P ＞ 0.05).There were no statistical difference between two groups in focus depth(P ＞ 0.05).Both groups had no serious glare.Though three eyes felt discomfort of halos in group control,only one eye felt the same phenomenon in group test.Conclusion AcrySof IQ ReSTOR SN6AD3 intraocular lens has negative spherical aberration by an aspherieal design in front surface,which makes it could counteract the positive spherical aberration of cornea.Consequently,IQ ReSTOR IOL gave good high-contrast visual acuity at distance,near and intermediate visual acuity.

Objective To discuss accommodative lag and near phofia varying with the near addition lenses and establish the mathematic equations of near adds and accommodative lag,near phoria respectively in order to getting the optimal adds,which would create the least error in accommodative and convergence responses.Methods To measure accommodative lag by Shin-Nippon and near phoria by Cover Test in 33 cm after providing 0D,+0.75 D,+1.50D,+2.00D,+2.50D five near adds orderly to myopes after 110 simple myopes with esophoria have been corrected far vision wholly basing on MPMVA norm;to analyze the relation of near adds and accommodative lag,near phoria by linearity regression.Results While increasing dioptric value of the near adds,accommodative lag and esophoria decrease gradually.Both accommodative lag[F(262.76,4),P ＜ 0.01]and near phoria[F(223.45,4),P ＜ 0.01]show statistically significant difference among the five near adds.There is linearity correlation between the optimal adds and initial accommodative lag(r=0.526,P ＜ 0.01)and between the optimal adds and initial near phoria (r=0.523,P＜0.01).Conclusion The range of optimal near adds can be gotten basing on initial accommodative lag and near phoria of myopic individual,so that it can be provided referenced strategy of determining the customized near addition lens for juvenile esophoric myopes.

Objective To understand and address our vision changes in primary and secondary students,in order to explore the prevention of juvenile myopia to provide a response and suggestions.Methods A random cluster sampling method,random sample of 90 rural and urban schools in Shandong,Qinghai,Yunnan,Shanghai and Wenzhou from May 2008 to September 2009,including 20 000 students(per province,4000×5)from elementary school and junior high school of focus and non-focus,primary 11 246,junior high school students 3673,high school 4220,of which 11 177 were from the urban students,rural students in 7962,aged 6 to 19 years old,male to female ratio is basically the same.For myopia and related survey.a total of 19,139 valid questionnaires were recovered.Using SPSS 13.0 software statistical analysis,different regions and different grades was used to compare the prevalence of myopia X~2 test.using Logistic regression analysis on the major risk factors for myopia.Results The survey are as follows,the prevalence of myopia in primary was 13.7%;the prevalence of myopia in junior high was 42.9%,the prevalence of myopia in high school was 69.7%.The highest rate of myopia prevalence of primarv school students in Shandong was 19.7%,the lowest was 11.9% in Qinghal,Shanghai,Wenzhou and Yunnan are similar;prevalence myopia of junior high in Wenzhou up to 50.6%,followed by Shanghai,and 47.2%,the lowest was 33.6%in Qinghai;the highest prevalence of myopia and high school students in Shandong,reaching 87.3%,followed by 72.0%in Wenzhou,and the lowest was 60.2% in Shanghai.Conclusion This survey shows that the prevalence of myopia of China's primary and secondary schools in coastal was higher than areas of mainland,in developed regions was higher than in less developed regions,and the plateau region and the strong ultraviolet light similar to the plain areas.Provincial prevalence of myopia increased from primary to high school continued the same trend.

：Objective To evaluatethe clinical experiences of one-stage repair of the interrupted aortic arch(IAA)associatedwith cardiac anomaly in neonates and infants.Methods From July 1996 to October 2008,48neonates or infants with IAA associated with cardiac anomaly underwent one-stagerepair.There are 30 males and 18 females ranging from 0.08 to 7.00 years old(1.97±2.05)withbody weight 3-20 (9±5)kg.42 patients had the middle-severe pulmonary hypertension(PH),thepulmonary pressure was 61-106(82±14) mm Hg and the pulmonary arterial resistance was66-762(315±259) dyn·s·cm~(-5) .There are 40 patients with type A IAA and 8patients with type B IAA,all patients had an associated patent ductus arteriosus,othercombined malformations included ventricular septal defect(VSD)in 33cases,atrial septaldefect(ASD)in 8 cases,mitral valve insufficiency in 6 cases,tricuspid valve insufficiencyin 5 cases,aortopulmonary window in 4 cases,double outlet of the right ventricule in 3cases,mitral valve stenosis in 2 cases,and et al.the operation was performed throughmedian sternotomy under the general anesthesia and cardiopulmonary bypass(CPB,the deephypothermia with circulatory arrest,the deep hypothermia with low flow rate,or the deephypothermia with low flow rate and circulatory arrest),the interrupted aortic arch repairwas achieved with the arch anastomosis in 30 patients and with an interposition graft in18 patients,the concomitant operations included VSD repair in 33cases,ASD repair in8cases,mitral valve plasty in 7cases,tricuspid valve plusty in 4cases,anrtopulmonarywindow repair in 4cases,intraventricular baffle tube repair in 2 cases,arterial switchoperation in 1 case,and et al.Results The time of the CPB and the aortic occlusion were112 to 375 min(182±52)and 24 to 287 min(99±45)respectively.The endotracheal intubationtime were 8 to 936 hours(179±133)and the ICU stay were 1-57 days(14±4).Byechocardiograph examination after operation,the pressure gradient across the arch wasobvious relieved and the combined cardiac malformations was satisfied corrected.3patients(3/48,6.25%)died during the perioperative period.The cause of death includedsevere pulmonary hypertension crisis,dysfunction of the pulmonary or the serious lowcardiac output syndrome,the main complications included reopen for bleeding in 2cases,tracheostomy in 2eases,the fight diaphragma paralysis in 1case,delayed sternalclosure in lcase,hydrothorax in lcase,the severe pulmonary infection in 1case.physicalactivities of the survivals increased obviously and discharged from hospitaluneventfully,all surviving patients had no late complications and death during thefollow-up 3 months to 12 years.Conclusion One-staged primary repair of IAA with otherintracardiac anomalies can be the preferred surgical approach and safely applied with goodresults as to lead a better life.

Objective To analyze the misdiagnoses of femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures.Methods Over the past six years,eight misdiagnosed cases of ipsilateral femoral neck or femoral fractures missed patients,aged 25 to 59 years old(mean:41.7),were treated at our department.An initial diagnosis of femoral shaft fracture was later revised as ipsilateral femoral shaft with supra-condylar fracture of femoral neck or femur.Femoral shaft fracture was fixed with armor plate,3-screw hollow compression fixation of femoral neck;two cases of femoral condylar fractures of distal femoral condyle with anatomical plate fixation and 1 case of intraoperative change into the retrograde femoral intramedullary nail fixation.Results The mean post-operative follow-up was 3.5 years.All fractures healed with excellent hip and knee functions.Conclusion For those with a strong reverse and torsional violence,femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures may be easily misdiagnosed.A preoperative conventional hip-knee X-ray film is an effective way to avoid a misdiagnosis.

Objective To enhance the understanding of drug-induced liver failure by analyzing theetiology,clinical features and prognosis associated factors of patients with drug-induced liverfailure.Methods Fifty-one cases of drug-induced liver failure admitted to our hospital from 2002-2007 werereviewed according to their drug history,clinical features,Laboratory tests,complications and prognosisassociated factors.Results The predominant etiological drugs were the traditional Chinese medicine(54.9%)and antitubercular agent(25.5%).Two predominant types of liver failure were acute liver failure(13.7%)and subacute liver failure(78.4%).The common complications were electrolyte disturbance,ascites and hepatic encephalopathy.The total improvement rate in patients was 29.4%.The incidences ofhepatic encephalopathy,electrolyte disturbance and PTA value had statistical difference betweenimprovement group and ineffective group.Conclusion The etiologies of drugs-induced liver failure aretraditional Chinese medicine and antitubercular agent in China.The prognosis of drug-induced liver failureremains poor.During the therapy of these drugs treatment,liver function test should be monitored.

Objective To evaluate initial application of coronary images from 320-slice dynamic volume MDCT(Toshiba Aquilion One dynamic volume MDCT).Methods 180 consecutive patients with suspected coronary artery disease were studied by ECG-gated 320-slice dynamic volume MDCT with nonhelical scanning mode in our hospital from November,2008 to January,2009.14 patients also underwent conventional coronary angiography.Images were retrospectively reconstructed under volume rendering technology,maximum intensity projection,muhiplanar reconstruction and curved planar reformation.Image quality was analyzed in axial 320-detector row images through the mid-RCA.Sensitivity,specificity,positive and negative predictive value of≥50% stenosis were calculated.Results 145(80.56%)cases had excellent images at average heart rate of 63 bpm.25(13.89%)cases had good images at average heart rate of 78 bpm.8(4.44%)cases had acceptable images at average heart rate of 85 bpm.2(1.11%)cases had unevaluable images at average heart rate of 96 bpm.No stair-step artifact was found 40 segments with≥50% stenosis were shown in CTA,while 37 segnent in CAG.The sensitivity,specificity,positive and negative predictive value of the 320 slice DMCT in detecting coronary artery stenosis ≥50% were 94.59%,94.80%,87.50% and 98.82% respectively.Conclusion Coronary images from 320-slice dynamic volume MDCT with wide area detector and non-helical scanning mode have excellent quality and less artifacts.320-slice coronary CT angiagraphy provides high sensitivity and specificity in detecting coronary artery stenosis.

Objective To evaluate the efficacy of interventional treatment of idiopathic longsegment occlusion of infrahepatie inferior vena eava(IVC)complicated with thrombosis.Methods Fourteen patients with idiopathic long-segment occlusion of infrahepatie IVC complicated with thrombosis underwent endovaseular recanalization.All procedures were performed under local anesthesia via internal jugular vein in combination with a unilateral femoral approach.First catheter-directed urokinase thrombolysis was performed.Then the occlusion of IVC was treated with balloon angioplasty and/or stent placement.Results Iliocavogram demonstrated an occlusion of IVC from intraheparic segment to infrarenal segment in 3 patients and an occlusion of infrahepatie IVC above renal veins in 11 patients.Thrombosis was located in IVC(n=14)and extended to iliofemoarl veins(n=12).Technical success was achieved in 12 patients.IVCs were reeanalized successfully.Complete or partial thrombua removal was accomplished in 8 and 4 cases,respectively.Recanalizafion failure occurred in 2 patients.No rethrombosis occurred over a mean follow-up of 12±6 months(range:1-36).And an asymptomatie restenosis of IVC was diagnosed by duplex scanning.Conclusion Intervenfional treatment of idiopathic long-segment occlusion of infrahepafie IVC complicated with thrombosis is a safe and effective method.

Objective To investigate the expression and the correlation of surviving,bcl-2 and HPV16/18 in cervical carcinoma.Methods Hybridization in situ was used to detect the expression of survivin mRNA and HPV16/18 DNA in 74 cases of CIN and 81 cases of cervical carcionma and 20 cases of normal cervical tissues.And immunohistechemical analysis was used to detect the expression of bcl-2 protein.Results The positive rates of survivin mRNA,bcl-2 and HPV16/18 in CIN were 44.6%,39.2% and 41.0% respectively versus 77.8%,70.4% and 81.2% in cervical carcinoma.The above three indices gradually rose in normal cervical tissue,CIN and cervical carcinoma.The expression of survivin and bcl-2 in CIN Ⅲ were obviously higher than those in CIN Ⅰ/Ⅱ.And it was obviously higher in cervical carcinoma with stage Ⅱ b-Ⅲ than those in stage Ⅰ-Ⅱ a.And it was also obviously higher in cervical carcinoma with a poor differentiation than those with a good or medium differentiation.The expression of survivin in cervical carcinoma with lymphatic metastasis was significantly higher than that without Lymphatic metastasis.There were no relationship between the expression of survivin or bcl-2 and the pathological type or tumor type of cervical carcinoma.The infection of HPV16/18 also had nothing to do with the clinical stage or pathological type or tumor type of cervical carcinoma.Inverse correlation was both observed in the expression of survivin and bcl-2 with survival rate.Thus a positive correlation between surviving,bcl-2 and HPV 16/18 was observed in cervical carcinoma.Conclusion Survivin,bcl-2 and HPV16/18 participate in the development of cervical carcinoma.It may be a useful guide in early diagnosis of cervical carcinoma,evaluation of surgery and chemotherapy and prediction of outcome.

：Objective To study therelationship between lumbar degenerative disease and morbidity of primary unilateral kneeosteoarthritis.Methods The clinical data of 115 unilateral knee osteoarthritis patientsand 119 bilateral knee osteoarthritis patients undergoing TKR(total knee replacement)atour hospital in 2008 were retrospectively analyzed.According to clinical signs of lumbardegenerative disease and radiological changes,these patients were divided into upper /lower / whole / none lumbar degenerative disease group respectively.X~2 test was performedto compare the difference of lumbar degenerative conditions between unilateral kneeosteoarthritis and bilateral knee osteoarthritis patients.Results The morbidity side oflumbar intervertebral disc protrusion or nerve root canal stenosis in primary unilateralosteoarthfitis patients was the same as the morbidity side of primary unilateralosteoarthritis.Lumbar degenerative disease morbidity [(34+20+15)/115=60%]of primaryunilateral knee osteoarthritis was higher than that[(3+5+4+6+19)/119=31.1%]of primarybilateral knee osteoarthritis(X~2=19.723,P=0.000);Upper lumbar degenerative diseasemorbidity(34/115=29.6%)of primary unilateral knee osteoarthritis was higher thanthat[(3+5)/119=6.7%]of primary bilateral knee osteoarthritis,(X~2=20.720,P=0.000);lowerlumbar degenerative disease morbidity(20/115=17.4%)of primary unilateral kneeosteoarthritis was higher than that[(4+6)/119=8.4%]of primary bilateral kneeosteoarthritis(X~2=4.227,P=0.040);there was no difference for whole lumbar degenerativedisease morbidity between primary unilateral and bilateral knee osteoarthritispatients(X~2=0.402,P=0.526).Conclusion The primary unilateral knee osteoarthritismorbidity is correlated with lumbar degenerative disease for the same elder patient.Upperlumbar degenerative disease can induce the incidence and aggravation of primary unilateralknee osteoarthritis;the flexion deformity of primary knee osteoarthritis may cause theaggravation of lower lumbar degenerative disease,even upper lumbar degenerative disease.

Objective To analyze the clinical data and pre-operative examination results of frontal lobe epilepsy and combine with intra-operative intraeranial electrical record in order to localize epileptic loci and to direct surgical therapy.Methods Preoperative EEG record and MRI scan were performed in 23 patients with refractory frontal lobe epilepsy.Among them,17 patients received interictal 18F-FDG-PETCT,11 received MEG examination,2 received functional MRI,10 received surgical operation and intraoperative intracranial electrical record.Results The positive predictive value of clinical features of epileptic seizure,interictal EEG,ictal EEG,MRI and PET-CT were 56.52%,56.52%,60.87%,54.55% and 94.12% respectively.Their consistent results helped to confirm the epileptogenie zone.MEG was more accurate than EEG.ECoE and VEEG monitoring was significant for operative guidance.Conclusion A series of examinations is necessary for the diagnosis of epileptogenic zone of frontal lobe epilepsy.The surgical outcome is related to the accuracy of epileptic loci localization and the removal of epileptogcnic zone.

Objective To discuss the effect of the new target controlled infusion(TCI)system in Chinese children undergoing minor operation and compared with TCI system with Marsh parameters.Methods Ninety ASA I,aged 3-5 yrs children undergoing elective unilateral high ligation of hernial sac under general anesthesia were randomly divided into group L(n=45)and group M(n=45)2 groups.All subjects were unpremedicated.Systolic blood pressure(SBP),diastolic blood pressure(DBP),ECG,SpO_2 and BIS were monitored.Patients of Group L and group M were anesthetized with propofol by Lian propofol TCI system and Marsh system respectively,combined with regional block.The target plasma concentration of TCI system was set at 6 μg/ml initially and up-regulated 1 μ/ml gradually if obvious body movement occurred while skin incision.If the target plasma concentration up to 8 μg/ml but there still had body movement,the TCI venous anesthesia was replaced by inhaled anesthesia.HR,RR,SBP,DBP and BIS were recorded in time points of baseline(T_0),after the induction(T_1),skin incision(T_2),3,5 min after skin incision(T_3,T_4),the end of operation(T_5).Complications,the awakening time and the number of cases which anesthetized with different propofol plasma concentrations or inhaled anesthesia were recorded respectively as well.Results The number of cases which completed the operation under TCI plasma concentration 6 μg/ml in group L were significantly more than those in group M(P ＜ 0.01).There were significantly different of T_1 -T_4 values of HR,RR,SBP,DBP and BIS in group M(P＜0.05),but not in group L.Compared with group L,T_2-T_4 values of HR,RR,SBP,DBP and BIS were higher in group M(P ＜ 0.05 or 0.01).Complications were lower in group L than those in group M.Conclusion Compared with Marsh system,propofol 6 μg/ml plasma concentration with the new target controlled infusion system applied in Chinese children undergoing unilateral high ligation of hernial sac could maintain stable hemodynamics,less stress reaction and complications.

Objective To determine the link between oral contraceptive pill(OCP)use and IVF/ICSI treatment outcomes under a short GnRH agonist protocoL Methods A total of 186 patients(one cycle each patient)received a short GnRH agonist protocol at Day 2 of menstrual cycle for IVF/ICSI.Among them,83 patients took OCP pre-treatment prior to the stimulation protocol(OCP group)and 103 patients received no OCP(non-OCP group).The triggering of final oocyte maturation was performed with 10 000 IU of hCG.Results The ongoing pregnancy rates per started cycle in the non-OCP group and OCP group were 27.8% and 12.7%(P ＜0.05)respectively.The clinical pregnancy rate and embryo implantation rate were significantly reduced in OCP group(clinical pregnancy rate 16.5%,implantation rate 11.2%)as compared with non-OCP group(32.2% and 19.9%,P ＜0.05).The endometrium on hCG day was thicker in nonOCP group than OCP group(9.5 mm vs 8.7 mm,P ＜ 0.05).Conclusion Pretreatment with OCP,as compared with initiation of stimulation at Day 2 of cycle in patients treated with GnRH-a short protocol antagonist appears to be associated with a significant difference in ongoing pregnancy rates per started cycle.

Objective To study the influence of ~(60)Co γ exposure on paracrine effect of marrow mesenchymal stem cells(MSC).To evaluate the function and construction after early stage of acute myocardial infarction(AMI)by injection of supematant liquid.To discuss the mechanism of prarcrine communication initially.Methods MSC were radiated by ~(60)Co γ with different dosage.The culture solution was collected peri-irradiation.The changes of Vascular endothelial growth factor(VEGF)、basic fibroblast growth factor(bFGF)、Interleuki-1β(IL-1β)in supernatant liquid were checked by ELISA.Using a rat model of AMI,the supematant liquid and control medium were injected intramyocardially and intraperitoneally according to the project.After 4 weeks,the cardiac dimension and functions were assessed,the microvessel density were detected.Results Three cytokines decreased significandy after irradiation,with the increasing in dosage of irradiation,the secretory volume of cytokines decreased greatly.When compared with the control group(group A 6.6±0.6)and medium group(group C 5.7±0.7),the microvessel density in supematant liquid group(group B 10.8±2.9)increased obviously,contributing to improvement in cardiac function and dimension.(Left ventricular internal dimension in diastolic(LVDd)postoporation:A 8.1 mm±1.5 mm,B 7.0 mm±1.5 mm,C 7.7 mm±1.1 mm;Eject fraction(EF)postoperation:A43.8%±8.9%,B51.5%±7.8%,C45.6%±8.1%.Conclusions ~(60)Co γ radiation exposure can degrade MSC' ability of paracrine communication.The paracrine effect which should take important role in improving the cardiac function after AML The mechanism of prarcrine is complex,neovascularization is the important link.

Objective Investigate whether preconditioning with diazoxide(DZ),a mitochondrial ATP-sensitive potassium channel opener,could enhance Akt protein to up-regulate Bcl-2/Bax protein ratio against apoptosis.Methods Cultured for 9-10 d in vitro,the hippocampat neurons of Sprague-Dawley rats were assigned to the following 5 groups randomly:Control(Group A),Anoxia(Group B),Anoxia+DZ100 μmoL/L(Group C),Anoxia+DZ100 μmol/L+5-hydroxydecanoate(Group D),Anoxia+DZ100 μmol/L+LY294002 50 μmol/L(Group E).Prior to oxygen deprivation,the hippocampal neurons were treated with DZ for 1 h per day and this treatment was persisted for 3 d.Each experiment was repeated for three times and each group contained 16 wells or 2 dishes of neurons for each time.Thereafter,neurons were derived of oxygen for 4 h.At 48 h of reoxygenation the neuronal optical density(A)were measured by MTT method,while the apoptotic rates were assayed by annexin V-FITC staining.The expressions of Akt,Bcl-2 and Bax proteins were detected and evaluated by Western blot.Results Compared with other pretreatment,DZ 100 μmoL/L led to the elevation of A,whereas promoted the decrease of apoptotic rate(P ＜ 0.05).Compared with those in other anoxic groups,the expressions of Akt protein and Bcl-2 protein in Group C were increased significantly(P ＜0.05),whereas the Bax density were reduced significantly(P ＜ 0.05).Preceding administration of 100 μmol/L DZ took protective effects on the neurons induced by anoxia-reoxygenation.Conclusions DZ 100 μmol/L increased Akt protein to up-regulate Bcl-2/Bax protein ratio against apoptosis induced by anoxia-reoxygenation.

With the progress of medical science, especially the rapid development of molecular biology and the deepening of evidence-based medicine, the disconnect between basic medical research and clinical application has changed, and translational research of medicine has been paid much attention to.

Case 1: A 41-year-old female patient.A 5 cm mass recurred 8 months after resection of malignant peripheral schwannoma in the left buttock, and swollen to the whole left buttock 10 months later. Physical examination showed that the mass in the left buttock was about 15 cm, hard in texture, with unclear boundary with surrounding tissues, no obvious tenderness, distension and pain in the left lower limb, and nerve root irritation sign (-).