The ophthalmological teaching of clinical laboratory and preventive medicine specialty should base on their own characteristics,and the teaching reform must be conducted form the four aspects of material,outline,practice and test to adapt to the demands of society development.

Objective To observe the early ultrastructural changes of the optic nerves after the brain impact injury. Methods Eighteen 15-week-old Wistar rats were used in the air-pressure brain impact injury examination. All of the rats underwent the procedures of right-parietal-bone fenestration after abdominal cavity anesthesia with 1% sodium pentolbarbital (45 mg/kg), and then they were divided randomly into 3 groups, i.e., mild injury group (8 rats) underwent with 7 kg of air pressure in distance of 11 cm; severe injury group (8 rats) with 7 kg of airpressure in distance of 8 cm; and control group (2 rats) underwent with the parietal-bone fenestration but without impact injury.The ultrastructural changes of the optic nerves were observed 1, 6, 24, and 72 hours after the injury by electron microscopy. Results The difference of ultrastructural changes of optic nerve was not obvious in wild injury group and the control group, and the lanthanum nitrate was only found in the blood vessels in optic nerve. The lanthanum nitrate entered the nerve stroma 1 hour after severe and increased as time goes on. Simultaneously, displayed dilatation of endoplasmic reticulum, cavitation and tumefaction of mitochondrion, vacuolation of nerve stroma, and vacuolation of some axis-cylinder were seen in the glial cells. Conclusion The brain impact injury may cause ultrastructural changes of the optic nerve and increase of permeability of blood vessels.

0.05 ) between two groups. The side effects were 7.7 % and 13.3 % in treatment group and control group, respectively. CONCLUSION: The combination of CLA+CBS+Met for 1 wk is an effective and safe treatment for eradication of HP infection with recurrent abdominal in children.

Objective To explore the clinical effect of inlay labial mucosa graft urethroplasty (LMGU) forⅠperiod in the complexity hypospadias.Methods According to the digital table,30 patients with complexity hypospadias were randomly divided into control group and observation group,15 cases in each group.The control group took Ⅰ period operation.The observation group received surgery by stages to complete.Routine urinary diversion during operation was performed after bladder puncture and ostomy,and in the control group,the urethra was placed with self-made 10-14F lateral hole silica gel stent,which was extracted out in the middle of the perineum,left or right.After 12-14d removal postoperative,the urination was observed.The catheter in the observation group was removed after 10 d,the urethroplasty is performed 6 months later.The clinical effects of the two groups were compared.Results In the control group,postoperative urinary fistula in 2 cases(13.3%),urethral orifice in 1 case(6.7%).In the observation group,postoperative urinary fistula in 2 cases(13.3%),6 months postoperatively in patients with urinary fistula to repair fistula was successful,urethral mouth narrow pure line incision.The incidence rate of complication of the control group was 20.0%,which of the observation group was 13.3%,the difference was not significant between the two groups(P>0.05).All cases were followed up for 1 to 2 years,did not occur urinary tract stones,hair growth,oral ulcers,such as the limited mouth complications.The penis was straight,beautiful shape.Conclusion Inlay LMGU Ⅰperiod is suitable for multiple surgery led to the lack of local incidence,urethral plate dysplasia and with severe penis abnormalities such as complexity in patients with hypospadias.The postoperative complications,micturition,penile appearance have no obvious differences compared with the stage,it is worthy of clinical popularization and application.

Objective To evaluate the clinical efficacy and security of retroperitoneal laparoscopic ureterolithotomy(RLUL) for impacted ureteral calculi after radical cystectomy and ileal conduit.Methods 5 patients with unilateral impacted ureteral calculi after radical cystectomy and ileal conduit received RLUL were selected,and a retrospective study was performed for manner,duration of surgery,complications and length of stay and other indicators,and the treatment effect was evaluated.Results All procedures were successful and the mean operation time was (82.0±27.7)min,the extubation time was (5.4±1.1)d,hospitalization time was (10.0±2.9)d.Postoperative follow up for 6-48 months,there were no obvious complications.Conclusion The RLUL showed satisfactory availability and security for management ureteral calculi after radical cystectomy and ileal conduit.

Objective To explore the clinical effect of laparoscopic radical nephrectomy by retroperitoneal in 65 cases.Methods 65 patients who received retroperitoneal laparoscopic radical nephrectomy were selected as the observation group,and their clinical data were analyzed.At the same period,S0 patients treated by open operation were selected as the control group.The clinical effect was compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,incision infection,pulmonary infection,hypercapnia,intestinal injury of observation group were lower than those of control group (t =7.60,8.38,8.83,x2 =8.33,6.19,4.08,4.08,all P ＜0.05).The positive margin rate,local recurrence rate,distant metastasis rate of two groups were not significantly different (P ＞ 0.05).Conclusion Laparoscopic radical nephrectomy by retroperitoneal has advantages of small wound,quicker recovery,less complications and good prognosis,which is worthy of clinical application.

Objective To approach the clinical curative effect of retroperitoneal laparoscopic adrenalectomy.Methods 120 adrenal tumors patients clinical data of urinary surgery in our hospital were analyzed,who was divided into detection group(80 cases) and control group(40 cases).Results The operation time,bleeding volume,postoperative exhaust time,hospitalization time,incision infection,pulmonary infection,intestinal injury of detection group were lower than those of control group (t =5.59,21.17,26.32,6.01,x2 =7.79,7.79,5.13,all P ＜ 0.05).Conclusion Retroperitoneal laparoscopic adrenalectomy has some advantages:the small incision,less trauma,faster postoperative recovery,less complication,,which was worth of applying.

Objective To investigate the effect of swifch from cyclosporine to FK506 on renal allograft outcome after initial acute rejection. Methods Clinical outcome of patients who experienced first acute rejection episode were retrospectively analyzed. After initial acute rejection, 23 patients were switched to FK506-based immunosuppression, and 63 patients continued CsA-based immunosuppression. Demographic data, lipid, serum creatinine, uric acid, incidence of recurrent acute rejection and graft survival were analyzed and compared. Results During one year after anti-rejection therapy, incidence of biopsy-proved recurrent rejection events was significantly lower with FK506 therapy (1/23, 4.35%) compared with CsA therapy (16/63, 25.40%)(P=0.033). 5-year graft survival rate of FK506-based immunosuppression group was higher than that of CsA-based immunosuppression group (100.0% vs 81.4%). Serum uric acid level of FK506-based immunosuppression group from 24 months to 36 months after initial rejection were significantly lower than that of CsA-based immunosuppression group [(265.5 ±147.9) μmol/L, (245.8±88.9) μmol/L vs (428.5±119.3) μmol/L, (441.2±125.3) μmol/L, P<0.01, respectively]. Conclusion Conversion to FK506 therapy can significantly reduce recurrent rejection episode, and decreasing serum uric acid level provides long-term benefits to graft survival.

Objective To explore the effect of acute humoral rejection on kidney graft survival.Methods 1098 patients received cadaveric renal transplant from January 2002 to December 2008 in our center. All patients were given triple immunosuppressants including tacrolimus or cyclosporine.According to patients who experienced biopsy-proved humoral rejection and cellular rejection within one year post-transplant, there were 53 cases in humoral rejection group, 109 in cellular rejection group (including 63 patients with borderline change), and 936 in normal group. Patients who experienced acute rejection received mythyl-prednisolone pulse, or received anti-CD3 antibody/plasma exchange/globulin. Clinical characteristics before operation including sex, age, HLA mismatch, panel reactive antibody, cold/warm ischemic time, graft loss rate and graft survival were compared among three groups. The effect of completely reversed cellular rejection and humoral rejection on graft survival was analyzed. Results There was no significant difference in sex, age and cold ischemic time among three groups, but there was significant difference in warm ischemic time, level of PRA and HLA mismatch between cellular rejection group or humor rejection group and normal group (P＜0. 05). During a follow-up period, the incidence of graft loss in humoral rejection group was 27.4 %, significantly higher than 7.3 % in cellular rejection group and 2.2 % in normal group, P＜0. 001. Kaplan-Meier analysis revealed the survival rate of grafts in humoral rejection group was significantly lower than in cellular rejection group and normal group (P＜0.001 ). After patients with irreversible rejection were excluded,there was no significant difference in the survival rate of grafts among the three groups.Conclusion Patients with acute humoral rejection survived with inferior graft outcome,but completely reversible rejection showed no effect on the graft survival.

Objective: To observe influence of enalapril maleate and folic acid tablet (EFA) on blood pressure and blood glucose levels in patients with H-type hypertension (HTH) complicated diabetes mellitus (DM).Methods: According to random number table, a total of 300 HTH + DM patients were equally divided into enalapril group, amlodipine group and EFA group.Levels of blood pressure, plasma homocysteine (Hcy), carotid intima-media thickness (CIMT), fasting plasma glucose (FPG), 2h postprandial glucose (2hPG), fasting insulin (FINS), 2h postprandial insulin (2hPINS) were measured and compared among three groups before, and one, 12 and 24 months after treatment.All patients were followed up for two years, incidence rates of cardiovascular and cerebrovascular events were compared among three groups.Results: Compared with enalapril group and amlodipine group on 24 months after treatment, there were significant reductions in levels of SBP[(134.65±7.25) mmHg, (136.00±8.62) mmHg vs.(128.62±5.00) mmHg], DBP[(84.79±4.26) mmHg, (88.47±7.25) mmHg vs.(74.29±5.06) mmHg], plasma Hcy[(11.18±5.21)μmol/L , (30.29±5.62)μmol/L vs.(9.72±2.47)μmol/L], CIMT[(1.30±0.19) mm, (1.46±0.37) mm vs.(0.95±0.38) mm], 2hPG[(12.50±1.70)mmol/L, (12.90±1.90)mmol/L vs.(9.50±1.00)mmol/L]and 2hPINS[(71.38±17.63)μU/ml, (78.42±21.49)μU/ml vs.(61.28±18.14)μU/ml], P<0.05 or <0.01.After two-year follow-up, compared with enalapril group and amlodipine group on 24 months after treatment, there was significant reductions in incidence rates of cerebrovascular events (11%, 23% vs.0) and cardiovascular events (2%, 11% vs.0) in EFA group, P<0.01 all.Conclusion: EFA tablets can significantly reduce blood pressure, blood glucose and Hcy level and effectively delay atherosclerosis progression in HTH+DM patients,its safety is good, which is worth extending.