Pressure sores result from many risk factors, which influence each other. In this paper, various aspects of the development of pressure sores in recent years were summarized, consisted of the main risk factors, pathogenesis, treatment and care methods. To control pressure sores should focus on prevention, and reflect the integrity and the target population.

Objective To explore the safe technique of caudate lobectomy for liver cancer in candafe lobe(LCCL).Methods The clinical data of 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. four procedures were used in the operations:(1)selection of appropriate skin incision, so as to obtain excellent exposure of operative field;(2)adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right;(3)preparatory placement of tapes for total hepatic vascular isolation,so that this procedure can be used when necessary;(4)selection of the ideal route for hepatectomy based on the condition of the tumor and, if necessary, the combined removal of multiple lobes. Among the 11 cases, simple occlusion of vessels of porta hepatis was used for candate lobectomy in 6 cases, while, in the other cases, the vessels were intermittently occluded several times or total hepatic vlascular isolation was used for the caudate lobectomy. combined partial right hepatectomy was done in 2 cases, combined left lateral lobectomy in 3 cases and caudate lobectomy alone in 6 cases.Results Operation was smooth and successful in all of the 11 cases, and there was no mortality. Conclusions Caudate lobectomy for LCCL can be safely performed when the above procedures are used.

Objective To evaluate the effects of exercise therapy in children with congenital heart disease. Methods To search databases such as PubMed, Medline, Science Direct, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang, VIP, China Biology Medicine for all the randomized controlled trials. After evaluating the quality of each article, the software of RevMan 5.3 were used to analyze. Results A total of 10 randomized controlled trials were included. Compared with the routine nursing, meta-analysis showed that exercise therapy can improve the peak oxygen uptake(MD=4.82,95%CI 2.25-7.39, P=0.0002) and the postoperative compliance (RR=2.84, 95%CI 1.75-4.63, P<0.01), shorten the postoperative hospital time(MD=- 4.41,95% CI - 6.15-- 2.68, P <0.01). Conclusions Exercise therapy can improve the pulmonary function and quality of life on children with congenital heart disease, shorten the postoperative hospital time, increasing the postoperative compliance. However, there were few research on present, so we need a large sample randomized controlled trials of long time to confirm the effects of exercise therapy.

Objective To observe the effect of meridian balancing on speech disorder in children with cerebral palsy. Methods 130 childrenaged 1.5~7 years old were divided into the control group (n=62) and treatment group (n=68). The control group received routine rehabilitationwhile the treatment group received meridian balancing in addition. Results The rate of improvement was 89.7% in treatmentgroup and 79% in control group (P<0.05). The rate was more for those with language retardation than with anarthria in the treatment group(P<0.01). Conclusion The meridian balancing is effective on speech disorder in children with cerebral palsy, especially for those with languageretardation.

Objective To investigate the incidence of aspirin resistance (AR) in patients with Type Ⅱ Diabetes mellitus (DM) and the correlation between AR and advanced glycosylation end products (AGEs) as well as the homeostasis model assessment for insulin resistance index (HOMA-IR). Methods A total of 69 patients with Type Ⅱ DM and another 23 patients without DM as control group were enrolled between October 2009 and July 2010. Blood lipid, blood routine, fasting blood glucose, Glycated hemoglobin (GHb/Hb A1c) ,fasting insulin were determined at first. After aspirin treatment for at least 7 days, platelet aggregation stimulated by arachidonic acid(AA) and adenosine diphosphate (ADP) were measured. In addition, the level of serum AGEs was measured by using ELISA assay. The degree of insulin resistance was obtained by using HOMA-IR. Results The incidence of AR in patients with Type Ⅱ DM was higher than that in the controls(30.4% vs. 8.7%, P = 0.037 ); the levels of serum AGEs and HOMA-IR in patients with Type Ⅱ DM were higher than those in the controls [ (359.56 ± 120. 14) pg/mL vs. (275.45 ± 118.06)pg/mL, P=0. 004; (4.42 ±4.78) vs. ( 1.5 ±0.78), P＜0.01, respectively]; platelet aggregation stimulated by AA in the diabetic group was correlated with serum AGEs and HOMA-IR( R =0.463, P ＜0.01; R=0.290, P =0.016, respectively); and platelet aggregation stimulated by ADP was only positively correlated with HOMA-IR(R =0.242, P = 0.045). Conclusions The incidence of AR in patients with Type Ⅱ Diabetes mellitus is higher than that in the controls, and diabetics with higher serum AGEs and HOMA-IR are more likely to develop aspirin resistant.

Objective To study the occurrence of apoptosis in acute rejection of hamster-to-rat liver transplantation and the molecular mechanism. Methods On the basis of establishment of hamster-to-rat orthotopic liver transplantation, the apoptosis in xenograft were observed by histology and in situ end-lebelling of fragmented DNA;the expression of Fas-L and TGF-?1 were observed by Immunohistochemistry. Rseults In acute rejection of liver xenograft, the apoptosis of hepatocyte was detectable, meanwhile, the expression of Fas-L and TGF-?1 were found. The more severe apoptosis, the more severe acute rejection , and the more expression of Fas-L and TGF-?1 . Conclusions Apoptosis as a mechanism of cell death exists in the acute rejection of liver xenograft, and it is closely related to the expression of TGF-?1 and Fas-L.

Background Small incision lenticule extraction (SMILE) is lack of eye-tracking system and there is controversy in the treatment of astigmatism.It is very important to understand its correction effctiveness for myopic astigmatism.Objective This study was to evaluate the clinical outcomes in the correction of myopic astigmatism between SMILE and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK).Methods In this retrospective study,95 eyes of 51 patients and 69 eyes of 40 patients with myopic astigmatism underwent the SMILE surgery and FS-LASIK surgery respectively in Tianjin Eye Hospital from December 2013 to July 2014 under the informed consent.No significant differences were found in spherical power,astigmatic power and spherical equivalent (SE) between the SMILE group and FS-LASIK group before surgery (all at P＞0.05).The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest refraction,slit-lamp microscopy,intraocular pressure and corneal topography were measured before surgery and 1 day,1 week,1 month,3 months after surgery.Vector analysis was used to calculate the components of astigmatism before and after surgery.Correction index (CI),index of success (IOS),angle of error (AofE) and flattening index (FI) were used to evaluate the correction effectiveness of astigmatism.Safety index and efficacy index were used to evaluate the recovery status of visual acuity.The corrected effectiveness was compared between the two groups,and the correlations of kappa angle with measured parameter were assessed by Spearman rank correlation analysis.Results The mean spherical power,astigmatic power and SE were (0.003±0.106),(-0.063 ± 0.126) and (-0.029 ± 0.101) D in the SMILE group,which were significantly lower than (0.112 ± 0.212),(-0.091 ± 0.142) and (0.067 ± 0.198)D in the FS-LASIK group (Z =-4.328,-3.197,both at P＜0.05).Vector analysis showed the postoperative with-the-rule astigmatism in the SMILE group and oblique astigmatism in the FS-LASIK group respectively,and the CI and F1 in the SMILE group were significantly lower than those in the FS-LASIK group (Z =-3.051,-3.126,both at P ＜ 0.05).The insignificant reduce in IOS and AofE were seen in the SMILE group compared with the FS-LASIK group (Z=-1.557,P=0.119;Z =-1.923,P =0.054).In addition,the safety index and efficacy index were not significantly different between the two groups (both at P ＞ 0.05).Negative correlations were found between safety index or efficacy index and preoperative kappa angle in the SMILE group (r =-0.258,-0.257,both at P＜0.05).Conclusions Both SMILE and FS-LASIK surgeries are effective and safe in correcting myopic astigmatism with good postoperative visual acuity.SMILE surgery shows less axis rotation and higher accuracy than FS-LASIK because of small incision and flapless procedure.The correction of cylinder can adjust based on experience of surgeon.

Background The visual quality and corneal biomechanical change are two major sides for evaluating the outcomes of cornea refractive surgery.It was determined that small incision lenticule extraction (SMILE) can improve the visual outcomes,but its long-term effects on corneal biomechanical are not known clearly.Objective This study was to investigate the change of corneal biomechanics and influence factors following SMILE.Methods A serial cases-observional study was performed.One hundred eyes of 58 patients with a mean spherical diopter (-5.00 ± 1.55) D and cylindrical diopter (-0.98 ± 0.87) D were included in Tianjin Eye Hospital from August 2011 to July 2013 under the informed consent.Corneal biomechanical parameters,including corneal resistance factor (CRF) and cornea hysteresis (CH) were measured using the ocular response analyzer (ORA) in preoperation and postoperative 1,3,6 and 12 months,respectively.The patients were grouped based on different lenticule thickness ratio (LTR),preoperative CRF values and residual stromal thickness (RST) separately,and the correlations of LTR,preoperative CRF and RST with ΔCRF and ΔCH were assessed.In addition,the associations between ΔCRF or ΔCH and related preoperation parameters were evaluated.Results The CRF and CH values at postoperative 1 month were (7.12 ± 1.20) mmHg and (7.90 ± 0.97) mmHg,which were significantly lower than preoperative (10.17±1.46) mmHg and (10.00±1.16) mmHg,respectively (t=15.552,P=0.000;t =13.411,P=0.000).The CRF values at postoperative 3,6 and 12 months were (7.06±0.90),(6.98 ± 1.11) and (6.87 ± 1.07) mmHg,and those of CH were (8.12 ±0.84),(8.12 ±0.97) and (8.14 ±0.86) mmHg,and no significant differences were found in CRF and CH between the adjacent time points (CRF:P =0.848,0.992,0.270;CH:P =0.370,0.791,0.777).Positive correlations were seen between the ΔCRF or ΔCH and LT/preoperative central corneal thickness (CCT) (LTR),preoperative CRF or preoperative CH values,respectively (LTR:r =0.468,P =0.000;r =0.299,P =0.004;preoperative CRF:r =0.696,P =0.000;r =0.590,P =0.000;preoperative CH:r =0.576,P =0.000;r =0.690,P =0.000).ΔCRF and ΔCH were negatively correlated with preoperative spherical equivalent diopter (r =-0.496,P =0.000;r =-0.292,P =0.010),the sum of preoperative spherical diopter and cylindrical diopter (r =-0.484,P =0.000;r =-0.293,P =0.005) or RST/preoperative CCT (r =-0.362,P =0.000;r =-0.243,P =0.019) and were positively correlated with lenticule (r =0.495,P =0.000;r =0.325,P =0.002).No significant association was found between ΔCRF or ΔCH and age,preoperative CCT and preoperative mean keratometry (all at P＞0.05).Conclusions Corneal biomechanical strength is decreased at the early stage after SMILE.However,biomechanical strength gradually enhances 1 month after surgery and tends to stability.The large RST/preoperative CCT can improve postoperative CRF and CH.The another main factor affecting the corneal biomechanics after SMILE is corrected-diopter.

Background Small incision lenticule extraction (SMILE) is increasingly applied in the correction of myopia and astigmatism.However,the early clinical outcomes of SMILE for different refractive myopia and astigmatism is seldom reported.Objective This study was to investigate the safety,efficacy,predictability and early stability after SMILE in low,moderate and high myopia.Methods A series of cases-observational study was carried out.A total of 195 eyes of 108 myopic patients were enrolled in Tianjin Eye Hospital from May to December 2012 under the informed consent.The patients were divided into the low (≤-3.00 D),moderate (＞-3.00 to-6.00 D) and high myopia (＞-6.00 D) groups according to different diopters,with 57 eyes,76 eyes and 62 eyes,respectively.SMILE was performed on all the eyes.The uncorrected visual acuity (UCVA)(LogMAR),best corrected visual acuity (BCVA) (LogMAR),equivalent sphere (SE),intraocular pressure,anterior segment and corneal topography were examined before operation and 1 day,1 week,1 month and 3 months after operation to evaluate the effective index (postoperative UCVA/preoperative BCVA),safety index (postoperative BCVA/preoperative BCVA),predictability and early stability of SMILE.The linear regression analysis was used to analyze the relationships between the attempted refraction and the achieved refraction postoperative 3 months in three groups.Results The percentage of UCVA (LogMAR)＜0.1 was 100％,97.1％ and 92.8％ in the low,moderate and high myopia group,respectively in 3 months after SMILE.The postoperative BCVA of all the operated eyes reached preoperative one.The residual SE was (-0.07±0.16),(-0.05 ±0.20) and (-0.08±0.27)D in the low,moderate and high myopia group,respectively in 3 months after SMILE.The percentage of residual SE±0.5 D was 100％,98.7％ and 93.6％ in the low,moderate and high group,and that of SE±1.0 D was 100％ in all of the groups.The postoperative corrected SE was gradually increased with the raise of predicted SE in the low,moderate and high myopia groups (r=0.942,0.959,0.957,all at P＜0.001).Conclusions SMILE is safe,effective,predictable and stable for the correction of low,moderate and high myopia.The corneal wound healing was slightly slower in the low myopia group than that in the moderate and high group.A slight regression of myopic power appears in high myopia eyes 3 months after SMILE.

Background The current evaluation of corneal optical quality after small incision lenticule extraction (SMILE) is based on the single factor,such as scattering,diffraction or aberration,and all of them are not comprehensive and objective methods.Modulation transfer function (MTF) and Strehl ratio (ST) are novel parameters of corneal optical quality,which can be used to assess the optical quality comprehensively.Objective This study was to evaluate the change of MTF and SR under the photopic and scotopic environment (3 mm and 6 mm pupil size,respectively) after SMILE procedure.Methods The study protocol was approved by Ethic Committee of Tianjin Eye Hospital,and written informed consent was obtained from each patient before any medical procedure.A series cases-observational study with self-control design was carried out.Sixty-three eyes of 32 myopia or myopic astigmatism patients who underwent SMILE surgery in Tianjin Eye Hospital were included from December 2013 to March 2014.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA) (LogMAR),the effective index (postoperative UCVA/preoperative BCVA) and refractive diopter were examined,and the MTF,SR and root mean square (RMS) on the anterior corneal surface were measured under the 3 mm and 6 mm pupil size at different spatial frequencies (10,20,30,40,50 and 60 c/d) by Sirius anterior analyzer before surgery and 1 week,1 month and 3 months after surgery,respectively.Results UCVA was ≥0.8 in 59,62 and 63 eyes in 1 week,1 month and 3 months after SMILE,with the percentage of 93.65％,98.41％ and 100％,and the effective index was 1.104± 0.128,1.126±0.145 and 1.158±0.208,respectively.The refractive diopter was normal in the eyes at postoperative 3 months.The MTFs of various spatial frequencies on the vertical and horizontal meridian under the 3 mm pupil size after SMILE were significantly higher than those before SMILE,while under the 6 mm pupil size,the MTFs were higher only on vertical meridian and 10,20,30 and 40 e/d,and there were not significant differences on the horizontal meridian (all at P＜0.05).The SRs under the 3 mm and 6 mm pupil size showed increasing softly after surgery in comparison with before surgery,and the SRs were higher under the 3 mm pupil size than those under the 6 mm pupil size at various time points (all at P＜0.05).There were not significant differences in RMS among different time points under both 3 mm pupil size and 6 mm pupil size (3 mm pupil size:F =1.348,P =0.184;6 mm pupil size:F=1.990,P=0.137).Conclusions SMILE provides a great improvement in corneal optical quality for myopia or myopic astigmatism patients,which is more distinct in photopic condition than that in scotopic condition.