Refractory glaucoma is one of the main blinding diseases in ophthalmology.Glaucoma drainage device implantation has become one of the main methods of refractory glaucoma.It has been widely used in clinic because of its advantages of safety,effectiveness and less complications.After a large number of clinical applications and innovative development of minimally invasive glaucoma surgery,glaucoma drainage device implantation shows its good treatment prospects.In this paper,the structural features of glaucoma external drainage device (Molteno,Schocket,Baerveldt,Human aqueous drainage,Krupin,Ahmed,Joseph,Whites,Optimed drainage device) and microin vasive glaucoma surgery (MIGS) (Ex-PRESS drainage device,Xen Gel Stent,CyPass Micro-Stent,Ab interno trabeculectomy trabectome,Hydrus Schlemm canal scaffold,iStent trabecular micro-bypass stent,SOLX Gold Shunt) were summarized.The drainage device implantations for glaucoma in the role of the refractory glaucoma were reviewed.

Objective To study the natural history of HIV infection among paid blood donors(PBD).Methods Two thousand three hundred and sixty four individuals infected with HIV/AIDS via blood donation in twelve villages of Henan province were included in this study,Retrospective data were analyzed in combination with a cross-sectional survey.Results The number of deaths were 709 among these 2 364 subjects under study by the end of 2004,with a mortality rate of 30.1%.Among 712 deaths,32.8% were companied with serious lung infections,18.1% were complicated with serious diarrhea,8.2%-with central nervous infections,8.2%-with cirrhosis,6.6%-with various types of cancers,3% died of suicide and 23% died with unclear cause.Of them 544 AIDS patients died before the ARV treatment was available in rural areas of Henan at the end of 2002,with a mortality rate of 23.0%.The median survival period for individuals with HIV infection was 9.5 years,and the median incubation period was about 8.5 years.Conclusion The median aurvival period for individuals with HIV infection via blood donation in rural areas of Henan was 9.5 years and the median incubation period was about 8.5 years among them.

Objective To assess the effects and side effects of ropivacaine combined with sulfentanyl in epidural anesthesia for caesarean section. Methods Two hundred ASA Ⅰ- Ⅱ patients scheduled for elective caesarean section were randomly divided into 2 groups (100 cases each):group S received 0.75% ropivacaine and 0.75 μg/ml sulfentanyl; and group R received 0.75 % ropivacaine. Epidural space L2-3 was punctured and the catheter was put upward 3 cm in all patients. Local anesthetic agents were administered until a complete sensory block was established extending upper T4-T6. In the operation, Bp, HR,SpO2, ECG were observed and the onset time, the upper spread and duration of sensory block were recorded.Assessed anesthetic efficacy and side-effects on newborn. Results The onset time [(4.5±1.2) min], the time needed to reach the highest sensory level [ ( 13±5) min ] were significantly shorter and the duration of sensory block [ (402±150 ) min ] was significantly longer in group S than those in group R (P < 0.05 ). There was no significant difference in the side effects such as tachycardia, nausea, vomiting, and shivering. Apgar score in newborn was not affected. Conclusion The anesthetic efficacy of epidural 0.75% ropivacaine is significantly enhanced which also has smaller local anesthetic requirements and low incidence of side-effects,in epidural anesthesia for caesarean section when sulfentanyl is added.

Objective To explore the surgical indexes, therapeutic efficacy and prevention of complications in treatment of some blood diseases by splenectomy (including laparoscopic splenecto- my). Methods The clinical data of 27 patients with blood diseases receiving splenectomy in our hospi-tal were retrospectively analyzed. Results The effective rate of splenectomy was 100% in 4 cases of hereditary spherocytosis, 76.47% in 17 cases of ITP and low in 6 cases of Non-Hodgkin's lymphoma.The postoperative incidence of complications was 7.41% (2/27). Conclusion Splenectomy is of the first choice for treatment of hereditary spherocytosis. Meanwhile, it is effective for most of the patients with ITP. It is an important approach for comprehensive of malignant lymphoma. Proper choice of indications and perioperative management are helpful for decreasing incidence of postoperative complications.

Objective To observe the curative effect of surgical treatment for eyelid basal cell carcinoma. Design Retrospective case series. Participants 33 cases with eyelid basal cell carcinoma. Methods 33 cases with eyelid basal cell carcinoma treated with surgery, standard excision in 17 case and Mohs micro excision in 16 cases were analyzed, postoperative appearance and function of re- eonstruetiiv eyelid, reeurence rate and survival rate were observed by follow-up survey. Main Outcome Measures Postoperative ap- pearance, function of reconstruetiiv eyelid, recurence rate and survival rate. Results After 6 month ~ 5 years follow-up survey with an average of 2.5 years, 28 of 29 cases obtained normal eyelid appearance, 1 case with lower eyelid gentle ectropium. 11 cases showed hy- perpigmentation in skin-grafting area in early stage, and became normal in half a year. Eyelid function of 29 cases were normal. Tumour relapse was seen in one case 2 years after standard resection,the cure rate was 94.12%. No tumor relapse was seen in group of mohs micro resection, the cure rate was 100%. Within five years postoperation, there was no death case caused by basal cell carcinoma re- lapse, except one dying from myocardial infarction and another dying of eerebrovaseular disease. Conclusions Operational excision is an effective approach for eyelid basal cell carcinoma. The effect of mohs micro resection is better than the one of standard resection. With dissociate skin grafting, fluctuate tarsal transmigration and dissociate skin grafting, eyelid appearance and function recover well.

Antiretroviral therapy(ART)has been started in an increasingly earlier period in clinical practice.However,owing to the failure of immunological reconstitution or maintenance of latent HIV-1 reservoir in present antiviral treatment,interleukin-2(IL-2)is widely used as an adjuvant to ART with a view to intensifying immunological reconstitution and to activating latent HIV-1 infections.Some conclusions could be drawn as follows,1)IL-2 can extend the half-life of CD+4 T cells and increase the number of CD+4 T cells.2)Compared with ART alone,IL-2 and HAART combination can not reduce HIV-1 related opportunistic infection or death.IL-2 clinical usage is mainly focused on purging HIV-1 reservoir.3)IL-2 combined with ART could increase out flow rate of HIV-1 latent reservoir to reduce HIV-1 infected quiescent memory cells in peripheral circulation even to an undetectable level.4)IL-2 is supposed to be used periodically and for a long period of time.

Objective To explore the causes of occupational exposure and methods of personal protection from occupational exposure.Methods Twenty seven cases with occupational exposure to HIV hospitalized in our hospital from 2003 to 2008 were analyzed retrospectively.Results Of the 27 cases with occupational exposure to HIV,8 were policemen,4-physicians,12-nurses and 3-laboratory technicians.Of them 4(3 medical workers)were of skin exposure,17(16 medical workers)were injured by sharp devices,and 6(all policemen)were injured by scratch or bite.Post exposure prophylactic interventions were provided for all of them,and no infection was identified after 12 month medical observation.Conclusion Regular training of occupational exposure to HIV for medical workers and judicial staff will be needed.

〔Abstract〕 Taking Wuxi People′s Hospital Affiliated to Nanjing Medical University as an example, the paper introduces the constitu-tion, software architecture and main functions of Clinical Decision Support System ( CDSS) .The system is integrated with Electronic Medical Records ( EMR) system, providing scientific and acurate information support for clinicians in the whole diagnosis process.It has positive significance to improve the work quality and reduce medical errors.

Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ)condyle-fossa position with normal and abnormal function are still contentious issues.Clinical opinions can be strong,but support in most published data (mostly univariate)is problematic.Distribution overlap,low sensitivity and specificity are a common basis to reject any useful prediction value.Notwithstanding,a relationship of form with function is a basic tenet of biology.These are multifactor problems,but the questions mostly have not been analysed as such.This review moves the question forward by focusing on TMjoint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint.Multifactor analysis allows the data to speak for itself and reduces bias.Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated,backed up by stepwise logistic regression.Explained vari-ance,R2 ,predicting normals from pooled TMJ patients was 32.6%,sensitivity 67.9%,specificity 85.7%;37% versus disc displacement with reduction;and 28.8% versus disc displacement without reduction.Significant osseous organisational differences between TMjoints with clicking and locking suggest that this is not necessarily a single disease continuum.However,a subset of joints with clicking contained char-acteristics of joints with locking that might contribute to symptom progression versus resistance.Moderately strong models confirm there is a relationship between TMJ osseous organisation and function,but it should not be overstated.More than one model of normals and of TMde-rangement organisation is revealed.The implications to clinical decision-making are discussed.

The influence of anisodamine on the cerebral blood flow in the uncompletely ischemic brains was studied with radioactive biomicrosphere assay. After the bilateral carotid arteries were occluded the cerebral blood flow drawmatically decreased and middle part of the hemisphere had the most severe reduction. Anisodamine 10mg ? kg-1 iv selectively increased the cerebral blood flow in this area and 20mg ? kg-1 increased that in the whole hemisphere. When it was used in the dose of 40mg ? kg-, the increasing effect on the cerebral blood flow became weaker. While the cerebral blood flow decreased, the myocardial blood flow increased significantly after bilateral carotid artery occlusion. Anisodamine 20mg ? kg-1 iv made it further increase and 40mg ? kg-1 iv made it decrease. The cardiac index was not influenced by bilateral carotid artery occlusion and anisodamine 10~20mg ? kg-1 iv, but was significanntly increased by anisodamine 40mg ? kg-1 iv. These results suggested that anisodamine may be used in the treatment of ischemic cerebral diseases and should be used in different doses according to different purposes.