Objective To investigate the clinical characteristic and risk factors of corticosteriod-induced ocular hypertension after vitreoretinal surgery.Methods Retrospective analysis was made based on the clinical data of 866 patients,including 126 corticosteriod-induced ocular hypertension(89 male,37 female,age range 9-70 years old) after vitreoretinal surgery during May 2002 to May 2005.Results All cases used glucocorticoid locally or systemically.Multi-variance logistic analysis showed that male,complicated vitreoretinal surgery,longer hospital stay,therapeutic duration with glucocorticoid,cataracta were the independent predictive factors,while myopia,hypertension,diabetes were not closely related to corticosteroid-induced ocular hypertension.Conclusion The incidence of corticosteriod-induced ocular hypertension after vitreoretinal surgery was 14.55%.The important factor leading to ocular hypertension is long-term application of glucocorticoid.

1. Fifty upper limbs of adult cadavers were dissected under an operating microscope.2. The ramus superficialis of the radial nerve is about 180 mm long, and springs from the radial nerve at a level about 16 mm below the medial epicondyle of the humerus. As the radial artery, it can be divided into superficial and deep parts by the overlapping of musculus brachioradialis. The junction between the two parts corresponds to a plane which divides the forearm into upper 2/3 and lower 1/3. The width of the ramus superficialis increases gradually as it runs downwards, and its cross section looks elliptical distally and somewhat circular proximally. Each of the two parts of the ramus superficialis receives 1～4 arteries from the lateral cutaneous arteries or muscular branches of the radial artery. Measurements were made to determine the position of the origin of these arteries.3. The nervus cutaneous antebrachii lateralis divides into two branches in the forearm, and receives 2～8 arteries mainly from the lateral cutaneous branches of the radial artery. It usually gives a branch communicating with the ramus superficialis of the radial nerve. The nervus cutaneous antebrachii lateralis can be found easily at the point just 5～6 mm lateral to the junction of the superficial and deep parts of the radial artery.4. The applied anatomy of the vascular pedicle nerve graft was discussed.

Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P<0.05).The operation time of the two groups were (194.69±47.99)min and (232.75±45.26)min respectively,and the difference was statistically significant (P<0.05).No significant difference was found in terms of rate of conversion to laparotomy,rate of intraoperative blood transfusion,postoperative hospital stay and complications (P>0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.

BackgroundOcular melanoma is a malignant tumor with a poor prognosis.To study its mode of pathogenesis and development is helpful for early diagnosis and treatment and improving prognosis. Objective This study was to analyze the location and pathological types of ocular melanoma,and explore the relationship of pathological types with prognosis of ocular malignant melanoma. Methods 110 clinical data and specimens of ocular melanoma were collected at West China Hospital,China.The specimens were examined by hematoxylin & eosin staining,immunochemistry and studying their ultrastructure.The growth location,histological classification,and their relationship with prognosis were analyzed and discussed.The clinicopathological records of the 1 l0 cases with ocular region malignant melanoma treated from January 1980 to December 2007 were analyzed.Results The primary locations of the tumors with respect to the tissue type were:66 cases in the uvea (60.00％ ),27 cases in the ocular surface tissue (24.55％),8 cases in the secondary lesion of orbit cavity (7.27％),7 cases on the eyelid skin (6.36％),and 2 cases in the lacrimal sac ( 1.82％ ).The neoplasm was classified according to pathological types:spindle-cell A type in 31 cases (28.18％ ),spindle-cell B type in 31 cases (28.18％),mixed-cell type in 25 cases (22.73％),epithelioid-cell type in 17 cases ( 15.46％ ) and other type in 6 cases (5.45％).The notability of diffusion or recurrence rate of the 5 pathological types showed statistical significance (x2 =14.463,P =0.006 ),and the rank in decending order was:other type,epithelioid-cell type,mixed-cell type,spindle-cell B type and spindle-cell A type.The clinical manifestations of ocular melanoma were dependent upon the lesion position without specificity.ConclusionsThe majority of the ocular malignant melanoma appears in the uvea and ocular surface tissue,and its common pathological types were spindle-cell type followed by mixed-cell type,epithelioid-cell type and other type.The highest recurrence rate is in other type of ocular malignant melanoma.Ophthalmologist should be aware of the clinical manifestation of ocular malignant melanoma.

Abstract: Objective　To compare the different effects of body mass index (BMI) and lean body mass index (LBMI) on the risk of all-cause death among elderly Chinese individuals. For the more scientific, accurate and convenient measurement of the elderly physique, analysis and evaluation of the health risk factors of the elderly in China. Methods　This study is based on follow-up data from 2014 to 2018, involving 5 990 participants who met the inclusion criteria in the Chinese Longitudinal Healthy Longevity Survey. Participants were grouped according to their BMI and LBMI, and both univariate and multivariate Cox proportional hazard models were established to compare the effects of BMI and LBMI on the risk of death in the elderly. According to gender, age, activities of daily living, and comorbidities, subgroup analysis was conducted to study the influence of LBMI in different subgroups. Results　The study population predominantly comprised females (52.9%, 3 167/5 990), with an average age of (84.7 ± 10.1) years, and most participants lived in rural areas (55.1%, 3 298/5 990). A majority were non-smokers (82.7%, 4 952/5 990) and non-drinkers (84.3%, 5 050/5 990). The prevalence of hypertension was 32.8% (1 966/ 5 990), diabetes 5.6% (334/5 990), and heart disease 12.9% (774/5 990). In the analysis of the impact of BMI on all-cause death in the elderly, univariate analysis showed that an increase in BMI was associated with a reduced risk of mortality. After adjusted by multiple factors (age, gender, living environment, marital status, average arterial pressure, number of children, smoking, drinking, hypertension, diabetes, heart disease, cerebrovascular disease, tumor, ADL/IADL, number of complications), compared to the normal group, the emaciated group (BMI<18.5 kg/m2) had the highest risk of death (HR=1.15,95%CI: 1.01-1.30); the overweight group (24.0 kg/m2≤BMI<28.0 kg/m2) had a lower risk of death (HR=0.78, 95%CI: 0.67-0.91). In the analysis of the impact of LBMI on the risk of death in the elderly, compared to moderate LBMI, lower LBMI was associated with a higher risk of death. Multivariate analysis showed that compared with moderate LBMI, a decrease in LBMI increased the risk of death, whereas an increase in LBMI did not show statistically significant differences in mortality risk in the elderly. Conclusion　In measuring fitness and quality of life in the elderly, LBMI has better representativeness and practical value.

Objective To observe the characteristics of vertical cast-off bloodstain pattern by different hitting-tools. Methods The regular hitting tools, a kitchen knife, a dirk, a plane set-hammer and an iron pipe, were selected. At a distance of 30 cmaway fromthe wall, the hitting tool with 5 mL fresh chick-en blood made the cast-off bloodstain fromtop to bottom. Then the holistic distribution characteristics ( length , width and density ) of cast-off bloodstain and morphology characteristics ( length , width and contact angle) of first single cast-off bloodstain were analyzed. Results The distribution length of cast-off bloodstain formed by dirk was minimum( P<0 .05 ) . The distribution width of cast-off bloodstain formed by kitchen knife was minimum(P<0.05). Except the pair of kitchen knife and plane set-hammer, the distribution density between each two tools had statistical differences (P<0.05). The length of first single cast-off bloodstain formed by plane set-hammer was longest compared (P<0.05). The width of first single cast-off bloodstain had statistical differences between kitchen knife and plane set-hammer, and between dirk and plane set-hammer (P<0.05). Conclusion The type of hitting tool could be inferred by the specific characteristics of cast-off bloodstain pattern formed by every specific type of hitting tool in crime scene.

Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Objective To evaluate the operation and review the clinical effectiveness of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon.Methods From January 2010 to January 2013,55 patients (25 men,30 women) with the mean age of 52.4 (range,37-65) years old who underwent arthroscopic tenodesis through double-needles positioning portal to treat proximal lesions of Biceps tendon were retrospectively analyzed.Shoulder pain of all the patients occurred in pre-operation and aggravated at the time of abduction shoulder joint,which affected the normal life for reasons of weakness.Diagnosis of magnetic resonance imaging (MRI) was proximal lesions of Biceps tendon,which was failed to respond to conservative management of six months.All patients underwent biceps tenodesis under arthroscopy with fixation of two suture anchors through bone,and removed tendon stump finally.All the portals of operation and observation of tendon fixation used double-needles positioning portal.We recorded the general condition of shoulder as the level of pain,sphere of activity,active forward flexion and intensity of adduction in pre-operation,3 months,6 months,12 months and 18 months after operation with American Shoulder and Elbow Surgeons (ASES),shoulder function score of Constant-Murley (Constant) and University of California,Los Angeles (UCLA).Then all data were analyzed statistically.Results All patients were operated successfully and got the mean follow-up of 20 months (range,18-24).The result of MRI showed well healing of tendon without rupture.The shoulder function had basically recovered.In pre-operation,ASES,constant and UCLA scores was 10.22±3.02,35.89±7.25,8.53±2.07 respectively.In 18 months after operation,the scores were 32.07± 1.26,89.75±4.07,31.87±2.07 respectively.The outcomes demonstrated that all scores in 18 months after operation had significantly improved,compared to pre-operation.Conclusion The technique of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon is reliable and simple,and can achieve satisfactory clinical outcomes.

Objective To study whether vancomycin dosage 2 g daily in Chinese adult patients would achieve the target serum trough concentration of 10-20 mg/L.Methods The data of 122 adult inpatients under therapeutic drug monitoring while receiving vancomycin were collected from September 2011 to December 2012.The correlation between vancomycin trough concentration and dosage,age,sex,body weight,concomitant medications were analyzed retrospectively.Results Vancomycin trough concentration was below the target concentration in 62.1% of the included patients.Age is an independent risk factor for attainting target concentration.Serum concentration was below target concentration in 70.0% of the patients below 60 years of age.Serum concentration was above target concentration in 62.5% of the patients above 60 years of age.Conclusions Clinicians and pharmacists should assess the dosage regimen of vancomycin cautiously,and age should be considered especially as an independent risk factor.

This paper dicusses the significance of drug clinical trials,and summarises the experiences in policy making,personnel trainning,supervising and management in drug clinical trials at the First People's Hospital of Changzhou,which may provide reference for drug clinical trials in China.