Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH).According to the appearance of vitreous and retina determined by optical coherence tomography,IMH can be classified as primary or secondary IMH,and IMH with or without vitreous attachment;Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction.According to the measured horizontal diameter,IMH can be classified as large,middle and small IMH.This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory,with a better description of the occurrence and development of IMH process.It should be used as the general principal to guide IMH classification,evaluation of surgical indications,selection of operative method,and estimation of surgical outcome.Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery.For complicated and large IMH,inverted ILM flapping can improve the closure rate;ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter.The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment,following the existing evidence-based medical evidence,and based on the new classification information,ocular and systemic features of each patient.

Objective To investigate the factors that influence the occurrence of hemorrhagic transformation (HT) in patients with acute massive cerebral infarction,and to provide references for clinical treatment.Methods The clinical data of 60 patients with acute ischemic stroke were retrospectively analyzed.All the 60 patients were divided into HT group and non-hemorrhagic transformation (NHT) group.Risk factors associated with cerebrovascular disease,such as general data (gender,age,histories of drink and smoke),history of past illness (hypertension,diabetes,coronary disease,atrial fibrillation and cerebral stroke) and clinical data (infarction location,therapeutic methods,blood pressure,blood glucose,blood fat,cholesterol,fibrinogen and et al),were compared between the two groups.Results Of all the 60 patients,HT rate was 35％ (21/60).Incidence of HT was higher in patients with past and present hypertension and hyperglycemia(P =0.009,0.013,0.005,0.008,0.017),and in patients with atrial fibrillation,anti-platelet therapy,infarction in cortex,and hypocholesterolemia (P =0.020,0.037,0.003,0.009).But gender,age,histories of drink and smoke and history of coronary disease were not significantly different between the two groups(P=0.935,0.309,0.196,0.717,0.058).Conclusion Hypertension,hyperglycemia,atrial fibrillation,hypocholesterolemia,anti-platelet therapy could be independent risk factors for HT in patients with acute massive cerebral infarction.

Objective To evaluate the sensitivity and specificity of CA242/CA72‐4 ratio in diagnosing early colorectal carcino‐ma .Methods Totally 87 blood specimens of colorectal carcinoma(CRC) were collected .The Chemiluminescence method was adopt‐ed to detect the levels of CA242 and CA72‐4 .Then the receiver‐operating characteristic (ROC) curve was used to analyze the sensi‐tivity and specificity of CA242/CA72 4 ratio in the diagnosis of CRC .Results Among 87 cases of suspected CRC ,56 cases (64 .37% )were eventually diagnosed as CRC ,31 cases (35 .63% ) were excluded from CRC ;the CA242 and CA72‐4 levels and CA242/CA72‐4 ratios in the CRC group were higher than those in the non‐CRC group ,the differences were statistically significant (P<0 .05) ,moreover the CA242/CA72‐4 ratio was more significant(P=0 .013) .The areas under curve (AUC) of CA242 ,CA72‐4 and CA242/CA72‐4 ratio were 0 .754 ,0 .621 and 0 .775 respectively ,in which CA72‐4 had no significant correlation with the early CRC ,while CA242 and CA242/CA72‐4 ratio had significant correlation with the CRC diagnosis(P=0 .013 ,0 .006) and their 95%confidence intervals (CI) were 0 .576-0 .851 and 0 .612 -0 .887;when the CA242/CA72 4 cutoff value was 2 .6(CA242=28 .6 , CA72‐4=11) ,the sensitivity for early diagnosis of CRC was 91 .32% and the specificity was 94 .57% .Conclusion The sensitivity and specificity of CA242/CA72‐4 ratio in the early diagnosis of CRC are higher than those of CA242 or CA72‐4 single index ,espe‐cially w hen the ratio is close to 2 .6 ,high attention should be paid to the possibility of CRC .

Objective To compare the clinical effect of unarmed cardiopulmonary resuscitationand cardiopulmonary resuscitationmachine in the emergency room.Methods One hundred cases patients with cardiopulmonary arrest in Hainan Agricultural Reclamation General Hospital from February 2014 to February 2016 were analyzed.The control group(n=50) were given unarmed cardiopulmonary resuscitation,while thetest group(n=50) were given ardiopulmonary resuscitation machine.Two groups' before and after cardiopulmonary resuscitation of arterial blood gas index(oxygen saturation (SaO2),C02 partial pressure (PaC02),oxygen partial pressure(Pa02)),cardiopulmonary resuscitation effectiveness and the success rate,and complications were compared.Results Before cardiopulmonary resuscitation,there were no significant differences on arterial blood gas index (SaO2,PaCO2,PaO2) between the two groups (t =0.069,0.097,0.121,P ＞ 0.05).After cardiopulmonary resuscitation,the SaO2,PaO2 of the test group were higher than that of the control group ((98.60± 8.51) ％ vs.(86.37 ± 7.84) ％,(13.84 ± 1.40) kPa vs.(8.69± 1.21) kPa),while PaCO2 of test group was lower than the control group ((3.24 ± 0.56) kPa vs.(6.41 ± 0.87) kPa),the differences were significant(t =7.474,21.665,19.679,P ＜ 0.05).The cardiopulmonary resuscitation of effective rate,success rate of test group were higher than the control group (84.00％ (42/50) vs.62.00％ (31/50),26.00％ (13/50)vs.10.00％(5/50),x2=6.139,4.336,P＜0.05).The total complication rate of the test group was lower than the control group(8.00％ (4/50) vs.28.00％ (14/50)),the difference was significant (x2 =6.775,P ＜0.05).Conclusion The clinical effect of cardiopulmonary resuscitation machine is significantly superior to unarmed cardiopulmonary resuscitation,which can effectively improve the patient's arterial blood gas state,improve the efficiency and success rate of cardiopulmonary resuscitation,and reduce the complications.

OBJECTIVE:To provide reference for reasonable iron supplement during pregnancy. METHODS:5023 iron sup-plement prescriptions for 800 delivery women receiving antenatal care and childbearing in our hospital in 2014 were analyzed retro-spectively. According to international authoritative guideline for gestational iron supplement,the rationality of iron supplement for pregnant women in our hospital was investigated in terms of timing,duration and dosage. RESULTS:The iron supplement timing and duration of 800 pregnant women all met the criteria;among 5023 iron supplement prescriptions,62 prescriptions of preventive iron supplement and 3875 prescriptions of iron supplement for iron deficiency were up to the standard. CONCLUSIONS:The dos-age of gestational iron supplement are unreasonable in our hospital at a certain extent. It is necessary to strengthen clinical medica-tion management to guarantee safe and rational iron supplement in pregnant women.

Calcaneal fractures, common injury to foot, usually require surgery if complicated with an obvious displacement. Since open reduction and internal plate fixation often leads to wound infection, more and more minimally invasive surgery has been adopted for calcaneal fractures. As a minimal invasive treatment, intramedullary fixation can be used to treat calcaneal fractures of Sanders types Ⅰ-Ⅳ. Calcanail and C-Nail are 2 major types of intramedullary nails that have been used to treat calcaneal fractures in Europe and the United States since 2011. This article reviews the basic structural features, biomechanical properties, surgical procedures and clinical efficacy of these intramedullary nails.

Objective To study three-dimensional computerized quantification for clinical stage Ⅰ lung invasive adenocarcinoma with different histopathological subtypes.Methods Pathological and HRCT data of 273 patients within clinical stage Ⅰ lung invasive adenocarcinoma underwent surgery from January 2005 to December 2012 were retrospectively collected.The proportion of ground glass opacity component and solid component in tumor were calculated by three-dimensional computerized quantification.All specimens were classified into 3 grades (grade 1 as the lepidic pattern of invasive adenocarcinoma,grade 2 acinar or papillary patterns,grade 3 micropapillary or solid patterns).The proportion of different components among different histopathological grades was evaluated by Kruskal-Wallis test.The correlation between components in tumor and histopathologic subtypes grade were evaluated by Spearman correlation.Results In 273 patients,49(17.9％) were assessed as grade 1,208(76.2％) grade 2,and 16(5.9％) grade 3.The proportion of ground glass opacity component and solid component in grade 1,grade 2,and grade 3 were 18.40％ (10.00％-33.45％),6.55％ (2.00％-18.00％),1.70％ (0.20％-3.85％) and 29.80％ (11.75％-47.35％),66.60％ (35.40％-83.85％),88.50％ (75.28％-93.60％),respectively.Significant differences among different histopathological grades were observed(x2=37.74,47.73,P＜0.01).The proportion of ground glass opacity component was negative correlation with histopathologic grade(r=-0.37,P＜0.01),while the proportion of solid component was positive correlation with histopathologie grade(r=0.42,P＜0.01).Conclusion Three-dimensional computerized quantification for lung invasive adenocarcinoma may predict histopathological grade.

Cholesteatoma ; diagnosis ; pathology ; Humans ; Petrous Bone ; pathology

Objective To explore the quality of life and its influencing factors among permanent colostomy patients. Methods Totally 219 permanent colostomy patients were recruited by convenient sampling method from January 2013 to December 2014 and investigated by Stoma Quality of life-Chinese Version, Stoma self-efficacy Scale, Stoma Self-care Scale-general version , and demographic questionnaire. Data were analyzed by SPSS 17.0. Results The score of Stoma-QoL-C among permanent colostomy patients was (54.86±12.17) points, which showed a dynamic V-type change as time went by. The quality of life of patients with colostomy for 1 to 3 years was especially low (50.46±13.77) points, P<0.01. The influencing factors of quality of life among permanent colostomy patients included self-efficacy, body image change, family members′acceptance of stoma except their spouses and self-care ability, while self-efficacy was the most important influencing factor. Conclusions The enterostomal nurses should pay more attention to the quality of life of the patients who have had colostomy for 1 to 3 years, enhance the patients self-efficacy and self-care ability, and help the patients to accept their body image changes and their family members′acceptance of stoma to improve their quality of life.