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 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

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 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 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.

BACKGROUND: Resin adhesives include total-etching, self-etching and one-step adhesive. The studies concerning their adhesive properties remain different.OBJECTIVE: To compare the bonding strengths of fiber posts cemented to root canals with etch-and-rinse adhesives and self-etch adhesives, and to observe the physical interface bonding conformation using laser scanning confocal microscope so as to understand the retention of macro-and micro-morphology relationship.DESIGN, TIME AND SETTING: In vitro comparative observation was performed at the laboratories of Prosthodontics and Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University from March 2008 to March 2009.MATERIALS: MATCHPOST fiber posts (Bisco, USA); etch-and-rinse adhesives (One-step, Bisco, USA) and self-etch adhesives (Panavia F adhesive system, Japan), fluorescein (Sigma, USA).METHODS: A total of 10 upper central incisor teeth, which had been freshly extracted for periodontal reasons, were selected,and the crown, 1 mm from the enamel-cementum junction, was cut. They were randomly divided into 2 groups with 5 specimens in each group. The fiber posts were bonded to root canals with One-Step or Panavia F which was tagged with rhodamine B.MAIN OUTCOME MEASURES: Each specimen was sectioned into two 2 mm-thick slices. A push-out test was made in a universal testing machine (EZ20), and confocal laser scanning microscopic (CLSM) analysis was performed to evaluate the primer penetration into dentin. The thickness of adhesive layer was measured by random software.RESULTS: The bonding strength of the group cemented with One-step was significantly greater than Panavia F (P < 0.05). The bonding strength of root crown was significantly greater than root apex (P < 0.05). One-step represented in CLSM image showed numerous and longer resin tags than Panavia F (P < 0.05).CONCLUSION: Etch-and-rinse adhesives (One-step) gained higher bonding strengths than self-etch adhesives (Panavia F).Resin binder to bond strength of fiber post and neck was greater than in the root apex.

Objective The present study was initiated to determine the expression profiles of the Fox genes in normal Balb/c mouse liver and their dynamic expression changes during fibrogenesis induced by experimental bile duct ligation(BDL).Methods RT-PCR was employed to detect 18 Fox family members including Foxo1,Foxo3,Foxm1,and Foxl1 in normal mouse liver.After mice were bile-duct-ligated,real time fluorescence quantitative PCR(FQ-PCR)was performed to ananlyze the dynamic mRNA expression changes of 9 inflammation-or proliferation-related Fox family genes.Results All the 18 Fox genes were found to be exDressed in the normal mouse liver and bile duct ligation profoundly influenced the expression of Fox transcriptional factor family genes.The expression of Foxol was significantly reduced by BDL,while FoxoL1 and Foxom1 expression were enhanced in this roodel.Moreover,the expression of Foxo1 and Foxo3 were the highest among the Fox members.Conclusion The Fox family genes-related to inflammation and proliferation were dynamically changed during BDL-induced liver injury,it indicates these genes were involved in the pathogenesis of liver fibrosis.

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.

AIM: To investigate the effect of hypoxia on the myofibroblast transdifferentiation from fibroblasts,and associated signaling of hypoxia on the production of collagen Ⅰ in cultured rat renal cortical myofibroblasts.METHODS: The study is composed of two relevant parts.In the first part,a normal rat renal interstitial fibroblast cell line NRK-49F was treated with hypoxia(1% O2) or normoxia(21% O2) for 6 h,12 h and 24 h.The expression of hypoxia inducible factor-1?(HIF-1?) was examined by Western blotting in order to make sure the hypoxic condition is reliable.The myofibroblast transformation from fibroblasts induced by hypoxia was assayed by detecting the protein levels of ?-smooth muscle actin(?-SMA).In the second part,the object was done on the primary cultured rat renal cortical myofibroblasts.Myofibroblasts were subjected to hypoxic or normoxic conditions for variety of times.The levels of HIF-1? in cell lysates and collagen I protein in supernatant culture medium and the activation of extracellular signal-regulated kinase(ERK)1/2 MAPK pathway were analyzed by Western blotting.RT-PCR was carried out to measure the levels of collagen I mRNA at different time points(2 h,4 h and 6 h).The distribution of HIF-1? in myofibroblasts was demonstrated by immunocytochemistry.The changes of collagen I production were detected after PD98059,a specific inhibitor of ERK1/2 activation pretreatment and during the hypoxia incubation.The activity of gelatinase matrix metalloproteinase-2(MMP-2) and MMP-9 in the supernatant medium from the cultured cells were assayed by gelatin zymography.RESULTS: Significant increased levels of HIF-1? protein appeared in cell lysates under hypoxia for 6 h.Furthermore,HIF-1? was translocated into nuclei of myofibroblasts after 6 h exposure of myofibroblasts to hypoxia.The levels of ?-SMA protein increased in NRK-49F under hypoxia for 12 h(187%?32%,P