Objective To evaluate the predictive value of cord blood bilirubin levels for subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.Methods A total of 292 term newborns with ABO hemolytic disease admitted from August 1,2011 to July 31,2012 were enrolled.Cord blood bilirubin levels were analyzed and the clinical characteristics of the neonatal hyperbilirubinemia group (n=34) and non-hyperbilirubinemia group (n=258) were compared.A receiver operating characteristic (ROC) curve analysis was performed to identify the predictive value of the occurrence and cut-off point of hyperbilirubinemia in term infants with ABO hemolytic disease.Paired-t-test,Chi-square test and Spearman correlation were used for statistical analysis.Results Of the 292 term infants with ABO hemolytic disease,34 cases had hyperbilirubinemia,with an incidence of 11.6％.Cord blood bilirubin levels were significantly associated with the presence of hyperbilirubinemia.The mean cord blood bilirubin level in infants who developed hyperbilirubinemia was (52.4± 13.2) μ mol/L,and was (35.0±8.0) μ mol/L for those who did not develop hyperbilirubinemia (t=7.540,P=-0.001).When cord blood bilirubin concentration increased,the incidence of hyperbilirubinemia gradually increased (x2=113.715,P＜0.001; rs=7.19,P＜0.001).The ROC area under the curve of 0.882 (standard error 0.005,95％CI:0.873-0.891,P＜0.001) was significant in predicting neonatal hyperbilirubinemia by cord blood bilirubin,and the occurrence of hyperbilirubinemia increased with increasing cord blood bilirubin level.Neonatal cord blood total bilirubin ≥ 50 μ mol/L predicted hyperbilirubinemia,and the positive predictive value was 0.683,negative predictive value was 0.959,sensitivity was 0.690 and specificity was 0.958.Conclusions Cord blood bilirubin level is useful in predicting subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.

Objective To evaluate the clinical value of cervical conization in diagnosis and management of cervical carcinoma in situ.Methods The clinic-pathological data of the 65 patients with cervical carcinoma in situ from Jan 2004 to Feb 2007 were analyzed retrospectively.Results(1)Of the 65 patients,59 cases had received the colposcopical multiple biopsies before the cervical conization and there was a correlation in pathology between cervical conization and colposcopical multiple biopsies in 46 cases(78.0%),but there was not much correspondence between cervical conization and colposcopical multiple biopsy in 13 cases(22.0%).(2)30 patients were received hysterectomy or cervical conization again.Patients with positive margins were significantiy more likely to have residual disease than those with negative margins(P

According to the anatomic classification,refractive surgery is divided into keratorefractive surgery,phakic refractive surgery and scleral refractive surgery.Most procedures for the correction of ametropia are performed on the cornea,with laser-assisted in situ keratomileusis(LASIK) being the most common one.LASIK has shown its limitations,however.For the correction of higher myopic and hyperopic refractive error,the procedure has considerable undesired effects,such as loss of contrast,glare,and iatrogenic keratectasia.Therefore,a variety of intraocular lens,known as phakic refractive surgery,have been designed to achieve full correction of high myopia and hyperopia without loss of accommodation.Phakic refractive surgery is different from kerato-or scleral refractive surgery in that it involves phakic intraocular lens,non-phakic intraocular lens and clear lens extraction +introcular lens.The author will outline recent progress in phakic intraocular lens and provide unifying concepts that are accepted by ophthalmologists.

OBJECTIVE:To explore the observation and nursing points of hemorrhage in intravenous thrombolysis after using alteplase. METHODS:128 patients underwent alteplase intravenous thrombolysis were selected as the research object. The occur-rence of hemorrhage in each part were observed within 48 hours after medication and nursed timely. RESULTS:128 patients re-ceived intravenous thrombolysis. 48 h later,26 patients suffered from hemorrhage complications (20.3%). Among them,there were 6 cases of nose bleeding (4.7%),8 cases of subcutaneous congestion (6.3%),6 cases of gingival bleeding (4.7%) and 6 cases of gastrointestinal bleeding(4.7%). There was no significant difference in the incidence of complications among those groups (P>0.05). The time of nose bleeding was (3.2 ± 1.3) h,the time of subcutaneous congestion (3.5 ± 1.2)h,the time of gingival bleeding(1.5±0.7)h,and the time of gastrointestinal bleeding(4.1±1.8)h. The time of gingival bleeding was earlier than that of other groups,with statistically significant difference(P<0.05). There was no statistically significant difference among other groups (P>0.05). CONCLUSIONS:In alteplase intravenous thrombolysis,nurses should closely monitor hemorrhage and complications, especially the complication of gingival bleeding. Find out the complications timely and nurse it as early as possible.

Objective To investigate the liver function of patients with chronic liver diseases undergoing gynecologic laparoscopic operations.Methods Twenty-six asymptomatic HBV carriers,28 mild chronic hepatitis,21 compensatory cirrhosis were assigned to undergo gynecologic laparoscopic operations.Liver function were tested and compared in these three groups before operation and on the 1st、3rd、7th day after operation.Results 1st day after operation,ALT and AST in asymptomatic carriers and mild chronic hepatitis groups were significantly higher than preoperation ( asymptomatic carriers:ALT P ＜ 0.05,AST P ＜ 0.05 ; mild chronic hepatitis:ALT P ＜ 0.05,AST P ＜ 0.05 ).Then they recovered on the 3rd day after operation ( asymptomatic carriers:ALT P ＞ 0.05,AST P ＞ 0.05 ; mild chronic hepatitis:ALT P ＞ 0.05,AST P ＞ 0.05 ).ALB,total bilirubin (Tbil) after operation were not significantly different from those before operation on every tested day in these two groups ( asymptomatic carriers:ALB P ＞ 0.05,Tbil P ＞ 0.05 ; mild chronic hepatitis:ALB P ＞ 0.05,Tbil P ＞ 0.05 ).In compensatory cirrhosis group,ALT,AST,Tbil were significantly higher on the 1st day,3rd day after operation than preoperation ( 1st day:ALT P ＜0.01,AST P ＜0.01,Tbil P ＜0.01 ;3rd day:ALT P ＜ 0.05,AST P ＜ 0.05,Tbil P ＜ 0.05 ).ALB levels were significantly lower on the 1st day,3rd day after operation than preoperation ( 1st day:P ＜0.01 ;3rd day:P ＜0.05 ).All the indexes recovered to the levels of preoperation on the 7th day after operation( ALT P ＞ 0.05,AST P ＞ 0.05,Tbil P ＞ 0.05,ALB P ＞0.05).Conclusions To some extent,gynecologic laparoscopic operations have some adverse effects on short-term liver function after operation in patients with chronic liver diseases.Compensatory cirrhosis patients present delayed recovery compared with asymptomatic carriers and mild chronic hepatitis patients.

Objective To evaluate the clinical effects of low-dose glucocorticoid hormone adjuvant treatment for mycoplasma pneumonia.Methods 118 cases diagnosed with mycoplasma pneumonia were randomly divided into two groups,including conventional treatment group (61 cases) and hormone treatment group (57 cases).The treatment group was given to the small dosage hormone,the control group was hospitalized for the same time which had not used the hormone the trouble.Both of two groups were given relieve a cough,breathe heavily evenly,the atomization inspiration and so on the complex therapy,and application large ring lactone class medicine including erythromycin or arch mildew element anti-infection treatment.On the basis of conventional treatment,the hormone treatment group was added with intravenous infusion of dexamethasone or oral prednisone.Compared with two groups of curative effects indexes including the defervescence time,the cough remission time,the moist crackles disappearance time and the hospitalization time.Results The defervescence time,the cough remission time,the moist crackles disappearance time and the hospitalization time were significantly lower in the hormone treatment group than those of the control group (t =-6.36,-2.04,-7.91,all P ＜ 0.05).Conclusion Low-dose glucocorticoid hormone adjuvant treatment could have the better curative effects for mycoplasma pneumonia for children.

10.3969/j.issn.2095-4344.2013.26.022

Objective To obtain the shear wave velocity(SWV) in breast tumors at different probe orientations.Methods SWV was measured on 92 breast tumors in 48 female patients with the probe placed on transverse,longitudinal and 45 degree planes.Pathological test results were followed up.Results Pathological tests showed benign tumors in 48 patients (92 tumors).Of the three planes,values of the biggest and the smallest SWV showed significant difference (P ＜0.001).Conclusions SWV differs on different planes of breast tumors.So the effect in different probe orientations should be considered using SWV for the differential diagnosis of breast tumors.

Objective To study the reasons and prophylaxes of conversion to laparotomy during gy-necological laparoscopic surgery. Method Clinical records of 36 cases of conversion to laparotomy out of 1143 cases of gynecological laparescopic surgery were analyzed retrospectively. Results The rate of conver-sion to laparotomy was 3.15%. The reasons of conversion to laparotomy were abdominopelvic cavity adhesion in 23 cases, technical difficulty and complication in 8 cases, malignant tumor in 3 cases, accounting for 63.89%, 22.22%, 8.33%, respectively. The rate of conversion to hparotomy in patients with a history of laparotomy was significantly higher than that without a history of laparotomy. The rate of conversion to laparoto-my in early stage of developing laparoscopic surgery was significantly higher than that in other stages. Con-clusions Abdominopelvic cavity adhesion is the primary reason of conversion to laparotomy during gyneco-logical laparoscopic surgery. Careful evaluation before surgery and improving ability of performance can de-crease the rate of conversion to laparotomy.

Objective To study the effects of vaginal estrogen application on blood flow of the lower urinary tract in post-menopausal women. Methods Arterial blood flow frequency spectrum, peak systolic blood flow, end-diastolic blood flow velocity and resistance index of the peri-urethra and neck of the urinary bladder, as well as changes in their genitourinary system, were measured with color Doppler ultrasound imaging in post-menopausal women before and three months after their use of premarin ointment containing natural estrogen per vagina. Results Three months after treatment with estrogen-premarin ointment per vagina in post-menopausal women, their peak systolic blood flow velocity of the peri-urethra arteries increased to 13.23 cm/s from 11.94 cm/s before treatment, end-diastolic blood flow velocity increased to 3.92 cm/s from 1.91 cm/s and resistance index decreased to 2. 79 from 3. 84 (P <0. 01 ). And, their peak systolic blood flow velocity of the arteries of the neck of the urinary bladder increased to 17.09 cm/s from 12. 77 cm/s before treatment, end-diastolic blood flow velocity increased to 2. 83 cm/s from 1.31 cm/s and resistant index decreased to 2. 78 from 3.78 (P<0.01). It indicated that local vasodilatation and decrease dresistance of the lower urinary tract made blood flow of the arteries of the peri-urethra and neck of the urinary bladder increase, urinary frequency and nocturia occurrence decrease, and sexual satisfaction improve.Conclusions Blood flow, symptoms of the lower urinary tract and their quality of life can be improved in post-menopausal women after treatment with natural estrogen-premarin ointment per vagina.