AIM:To explore the possible alteration of refraction and estimate the potential impact of visual quality, investigate the impact of intraocular structure between the simple operation and the combination of phacoemulsification and intraocular lens implantation, and observe the influence among various tamponade materials application.
METHODS: Ultrasound biomicroscopy ( UBM ) and intraocular len ( IOL ) Master were measured for simple vitrectomy patients ( the simple group, 37 eyes ) and vitrectomy combined with cataract surgery patients ( the combined group, 11 eyes ) . Several parameters were measured such as the anterior chamber depth ( ACD ) , angle opening distance ( AOD ) , trabecular iris angle (TIA), axial length (AL), et al . The simple group was further divided into three sub - groups by various tamponade materials in vitreous: silicone oil group, gas group and equilibrium liquid group. All patients were measured including ACD, AOD250, AOD500, TIA500, AL and corneal curvature (K1, K2) parameters preoperatively and 2wk postoperatively.
RESULTS: AOD250, AOD500, TIA500 and AL were decreased 0. 13±0. 21mm, 0. 16±0. 22mm, 8. 68o±9. 72o and 0. 18±0. 24mm ( all P<0. 05 ) respectively in the simple group postoperatively. ACD, AOD250, AOD500, TIA500 and AL in combined group increased 0. 95±0. 54mm, 0. 13±0. 12mm, 0. 22±0. 20mm, 11. 49o±11. 06o, and 0. 45±0.30mm ( all P < 0. 05 ) respectively after operation. Alteration of ACD, AOD250, AOD500, TIA500 and AL were different between simple group and combined group ( P<0. 05). Of data from various tamponade materials sub-groups, ACD, AOD250, AOD500 and TIA500 of the gas group reduced 0. 19±0. 17mm, 0. 14±0. 09mm, 0. 20±0. 12mm, and 12. 02o±6. 64o respectively after operation ( P<0. 05), the AOD250, AOD500, TIA500 and axial length of silicone oil group decreased 0. 19±0. 25mm, 0. 21±0. 26mm, 10. 44o±9. 67oand 0. 23±0. 19mm respectively after operation ( P < 0.05 ) , while equilibrium liquid group had no significant changed in all intraocular structure (P>0. 05). However, neither the corneal thickness nor curvature (K1, K2) were changed postoperatively (P>0. 05).
CONCLUSION:Alteration of anterior segment and axial length in combined group are different from that of the simple group, while the corneal thickness and corneal curvature ( K1, K2 ) are not obviously changed in all groups. Meanwhile, various tamponade materials can also cause different impact on intraocular structure and refraction. In brief, alterations of intraocular structure might cause discrepant refractive changes and potential influence of visual quality.

Objective To discuss the expansion model of the eyeball and investigate the morphologic characteristics of high-my- opic eyeball through the dimensional measurement in high-myopia and emmetropia by MRI. Design Case controll study. Participants Thirty-two emmetropes (60 eyes) and 33 high myopes (60 eyes) were enrolled, without eye diseases and history of ocular surgery or in- jury. Methods 60 high-myopic eyes and 60 emmetropic eyes were measured with MRI (I.5T,PHILIPS) to get the data of three inner ocular dimensions, intraocular volume and the volume of different parts. Main Outcome Measures Three dimensions and volumes of eyeballs. Results The average value of axial (28.16?2.80 mm), horizontal (22.87+1.23 mm) and vertical length (23.40?0.99 ram) of high-myopic eyes were much bigger than those of emmetropic eyes(P=0.000), especially the axial length( with difference of 5.38 mm); The axial length was correlated with refractive error (0.36 mm/D,r~2=0.88, P=0.000). The average value of the whole ocular volume (7. 46?0.89 ml) and vitreous volume(6.90?0.8 ml) of the high myopic eyes were bigger than those of emmetropic eyes(P=0.000), while ante- rior segment volume and lens volume were about the same as that of emmetropic eyes (P=0.220, P=0.630). Conclusions The three di- mensions of high-myopic eyes were significantly longer than that of emmetropic eyes. In high myopes, the increased vitreous volume lead to the increase of the whole ocular volume. There may be two models in the ocular expansion of high myopia: global expansion and axial elongation expansion. More serious refractive error cause more obvious expansion in axial elongation.

BACKGROUND: Hemiarthroplasty is widely recommended for the treatment of femoral neck fractures in elderly patients, but it is controversial in choosing cemented or cementless fixation types. OBJECTIVE: To compare the clinical effects of cemented hemiarthroplasty with cementless hemiarthroplasty for the treatment of femoral neck fractures in elderly and to provide a scientific basis for the selection of clinical prosthesis. METHODS: 167 elderly patients with femoral neck fractures undergoing hemiarthroplasty in the Foshan Hospital of Traditional Chinese Medicine from March 2013 to March 2015 were enrolled in this study. According to the type of prosthesis, patients were divided into cementless group (n=81) and cemented group (n=86). The operation time, intraoperative blood loss, hemoglobin levels 1 day after surgery, reoperation rate, mortality and complications at 1 year after surgery were compared. After surgery, clinical function of hip joint was assessed by Harris scoring system. The pain was evaluated by Visual Analogue Scale. RESULTS AND CONCLUSION: (1) All patients were followed up for ≥ 12 months. (2) The operation time in the cementless group was significantly shorter than that in the cemented group (P < 0.01). (3) There was no significant difference in the intraoperative blood loss and hemoglobin levels at postoperative 1 day (P > 0.05). (4) There were no significant differences in Harris hip scores and Visual Analogue Scale score at various time points between both groups (P > 0.05). (5) The incidence of thigh pain in cementless group was slightly higher than that in cemented group at 1 week, 1 and 6 months after operation, but the differences were not statistically significant (P > 0.05). Two patients died from myocardial infarct in the cementless group, and one patient died from pulmonary infection in the cemented group. The mortality was not significantly different at postoperative 1 year between the two groups (P > 0.05). No complications, such as prosthesis loosening and sinking, periprosthetic fracture, and periprosthetic infection, which needed to be refurbished, occurred in both groups. (6) Our findings suggest that both cemented and cementless hemiarthroplasties can obtain satisfactory effect in the treatment of femoral neck fractures in the elderly patients. Cementless hemiarthroplasty can significantly shorten operation time.

Objective To evaluate the nutritional status of iodine of pregnant and lactating women in coastal and inland areas of Zhejiang province,and to provide scientific basis for iodine supplementation.Methods In 2009,five coastal cities,five coastal counties and three inland areas from Zhejiang province were selected by the cluster sampling method,and one sub-district(township) was randomly selected in each city (county),then one community (village) was randomly selected in each sub-district (township).Thirty pregnant women,thirty lactating women and fifty children aged 8 - 10,were randomly selected in each community(village) as the investigation objects to collect instant urine samples to detect urine iodine,and to collect thirty resident edible salt and some water samples to detect salt iodine and water iodine,if the numbers of water source were more than 5 then 1 water sample was collected by their location of east,south,west,north and center in each community(village),otherwise,the numbers of water samples collected were equal to the number of community (village).Results The medians of salt iodine of coastal city,coastal county and inland area were 28.42,25.29,and 33.24 mg/kg,respectively,and the medians of water iodine correspondingly were 5.41,11.52,and 2.80 μg/L,respectively.The medians of urinary iodine of pregnant and lactating women in Zhejiang province were 148.72 and 161.34 μg/L,respectively,which were less than that of children aged 8 - 10(231.02 μg/L,Z =8.57,8.24,all P ＜ 0.017).The medians of urinary iodine in pregnant women from different areas were ranked in order as inland areas(211.42 μg/L),coastal counties (150.51 μg/L) and coastal cities (123.33 μg/L,Z =2.80,5.31,2.42,all P ＜ 0.017),and in lactating women,the medians of urinary iodine in inland areas( 197.43 μg/L) was higher than that in coastal cities( 139.64 μg/L,Z =4.03,P ＜ 0.017).Conclusions The overall levels of iodine nutrition in lactating and pregnant women in Zhejiang province are in the appropriate level,but that of the pregnant women in the coastal cities is inadequate.

Objective To investigate the stress distribution in a cemented femoral component in elderly patients with a partial marrow type Ⅰ intertrochanteric fractures and to compare differences in the stress distribution after a long-and short-stem prosthetic replacement.Methods Spiral CT images of right femur of the volunteer were obtained and processed with Mimics software and modeling software to reconstruct a three-dimensional model of the femur.Based on this,a three-dimensional physical model for partial marrow type Ⅰ intertrochanteric fractures,long-and short-stem femoral prostheses,and cement mantle was established.Subsequently,a three-dimensional finite element model of long-and short-stem prosthetic replacement for intertrochanteric fractures was established using the finite element analysis software,and biomechanical analysis was implemented for the model.Results No significant changes in stress distribution of the femur occurred after long-or short-stem prosthetic replacement.Stress on the femur still presented a gradual increase from the proximal end to the distal end,peaked at the lower 1/3 of the medial and lateral junction and then decreased at the end.A stress concentration zone formed in the medial and lateral end of cement-stem interface in short-stem prosthetic replacement.Besides,the maximum value of stress in the lateral interface reached 15.3 MPa,but without surpassing the fatigue strength of the bone cement.Whereas,a stress concentration zone formed in the distal medial and lateral part of cement-stem interface and the medial middle part of the interface in long-stem prosthetic replacement and the maximum value was also lower than the fatigue strength of bone cement.No significant stress concentration zones were found in the femoral calcar reconstructed using bone cement.Conclusions Cemented long-or short-stem prosthetic replacement achieves no significant alteration in stress distribution of the femur.Loosening probability of the cemented long-or short-stem prosthesis is almost the same,but the latter has advantages of shorter surgery time,minor trauma,and fewer complications and may be more suitable for treatment of the elderly patients with a partial marrow type Ⅰ intertrochanteric fractures.

Objective To observe the protective effect of gradual ischemic postconditioning (IP) capable of improving reperfusion on reperfusion injury in patients with ST-segment elevation acute myocardial infarction (STEAMl) undergoing primary percutaneous coronary intervention (PPCI).Methods 102 in-patients with STEAMI undergoing PPCI in the Department of Cardiology in the First People's Hospital of Kunshan City Affiliated to Jiangsu University from February 2011 to August 2014 were enrolled in this study. They were divided into three groups by a random number table: IP group (32 cases), gradual IP group (30 cases) and routine reperfusion group (40 cases). In IP group, after the opening of the infarction related blood vessel, ischemic postconditioning within the first minute of arterial reperfusion was made through three episodes of 1 minute inflation and 1 minute pressure withdrawn of an angioplasty balloon, and then persistent reperfusion was carried out. In the gradual IP group, the patients received three times of gradual angioplasty balloon inflation and denation, 1 minute/1minute, 30 seconds/30 seconds and 15 seconds/15 seconds respectively, presenting the gradual change of IP time. In the routine reperfusion group, after the opening of blocked blood vessel, the patients underwent routine PCI to persistently recover the coronary artery blood supply. The changes of related lead ST segment regression (Sum-STR), incidence of reperfusion arrhythmia, corrected thrombolysis in myocardial infarction (TIMI) franle count (CTFC), peaks of MB isoenzyme of creatine kinase (CK-MB), left ventricular ejection fraction (LVEF) and frequency of adverse events in follow-up period were compared among the three groups.Results The baseline characteristics were comparable in three groups. The incidence of ventricular premature beats was significantly lower in gradual IP group than that in routine reperfusion group [30.0% (9/30) vs. 55.0% (22/40),P < 0.05], and although theincidence of ventricular premature beats was lower in IP group than that in routine reperfusion group [34.4% (11/32) vs. 55.0% (22/40)], no statistically significant difference was found (P > 0.05). The incidence of ventricular tachycardia was significantly lower in IP and gradual IP groups than that in routine reperfusion group [15.6% (5/32), 13.3% (4/30) vs. 40.0% (16/40), bothP < 0.05]. The incidences of ventricular fibrillation, bradyarrhythmia and sinus arrest were lower in IP group and gradual IP group than those in routine reperfusion group, but no statistically significant differences were found (allP > 0.05). In IP group and gradual IP group, the Sum-STR incidence, CTFC, CK-MB peaks were lower than those of routine reperfusion group [Sum-STR: (56.7±18.3)%, (57.3±21.5)% vs. (44.6±21.6)%; CTFC: 25.47±5.37, 24.46±6.41 vs. 31.62±7.56; CK-MB peaks (U/L): 126.3±78.5, 121.6±82.5 vs. 147.4±72.5; allP < 0.05], the effect of gradual IP group being the best among the three groups. The levels of LVEF were slightly higher in IP and gradual IP groups than the level in routine reperfusion group (0.507±0.042, 0.511±0.062 vs. 0.497±0.062), but no statistically significant difference was found (bothP > 0.05). In routine reperfusion group, one patient died because the ventricular fibrillation could not be corrected and another one died of no-reflow during operation. Each group had 1 patient died during the 4 weeks of follow-up after operation, in the routine reperfusion group, one died of refractory heart failure, and the cause of death of other two patients, one in IP group and another in gradual IP group, was considered due to subacute thrombosis in stent. Major bleeding events were not found in each group.Conclusion Gradual IP can ameliorate myocardial reperfusion injury more significantly in patients with STEAMI undergoing PPCI.

Objective Hepatic artery (HA) reconstruction is one challenging procedure in pediatric liver transplantation (PLT).Here we review the first 115 microsurgical reconstructions of HA in PLT performed by a single surgeon,aiming to demonstrate the learning curve and the problems encountered.Methods From July 2016 to January 2017,a series of 115 microsurgical reconstructions of HA in PLT for end-stage liver disease were finished by one single surgeon with 4-year liver surgery experience and 2-week microsurgical training.HA reconstruction was performed with an operating microscope (Carl-Zeiss S88).Reconstruction was completed with interrupted sutures with 8-0 or 9-0 Prolene using the double clip for fixation.The blood flow was examined by Doppler scan daily after PLTs in first week and then once in 2nd week and first month for patency.A total of 143 artery anastomoses were performed in 115 PLTs.The age ranged from 3 months to 9 years.Indications for PLT included biliary atresia (105/115),Alagille syndrome (5/115),PFIC (3/115),Caroli disease (1/115),methylmalonicacidemia (1/115) and glycogen storage disease (1/115).Most of the PLTs were living donor liver transplantation (107/115),along with OLT (5/115) and split LT (3/115).Results The diameter of the arteries was mostly less than 2 mm (98/115).Up to date,one HA thrombosis (HAT) occurred at D8 after LT and 4 cases suspected as temporal HA stenosis (HAS) around 2 weeks after LT,which manifested as low velocity (<20 cm/s) and resistance index (<0.50) by Doppler.The HAT case failed in emergent re-anastomosis,but had a spontaneous recanalization at 3 weeks and is now in good condition without biliary problem.All the HAS children recovered to normal flows at first month.All children with HA complications started warfarin upon detection,with a targeted INR between 1.5-2.0.There were 6 deaths in this series including 5 cases of infections and 1 case of graft failure.Learning curve suggested a two phases growth (first 44 cases practicing phase vs.next 71 cases mature phase),which can be attributed to experience accumulation in terms of precise of manipulation,choice of inflow arteries for better match and stronger pulsation,avoidance of length redundant,prevention of kink.All the HAT and HASs happened in practicing phase while outcomes were excellent in mature phase.Moreover,time for each anastomosis was significantly shortened in second phase from 45-70 min to 30-55 min.Conclusion Microsurgical technique is highly safe in pediatric HA reconstruction,especially for very tiny arteries.It is possible to achieve low risk of complications for a new surgeon with adequate experience in liver surgery and microsurgical training.However,more surveillance and timing anticoagulation therapy is required before the mature of microsurgical technique.

Objective To assess the effect of lifestyle intervention on risk factors of chronic disease.Methods A total of 400 adults with high-risk of chronic disease received 3 months' lifestyle intervention.The effect of lifestyle intervention was then estimated.Results A total of 387 adults took physical examination.After lifestyle intervention,body mass index,waist circumference,blood pressure,glucose,glyceride,total cholesterol,and high density liopportein were significant decreased (t values were 27.50,19.01,7.46,6.56,5.29,7.74,7.27 and-7.64,respectively; all P＜0.05); however,low density liopportein showed no significant difference (t=0.73,P=0.469).A total of 373 adults had lifestyle and cardiovascular risk estimated.The scores of lifestyle and physical exercise showed statistically significant difference before and after lifestyle intervention (x2 values were 48.405 and 50.778,respectively; both P＜0.05).However,diet,alcohol drinking and cigarette smoking showed no significant difference (x2 values were 0.087,0.112 and 1.410,respectively; all P＞0.05).Moreover,the estimated cardiovascular risk showed significant difference (x2=10.284,P＜0.05).Conclusion Lifestyle intervention could be an effective tool for those with higher risk of chronic disease.

BACKGROUND: Coronary microembolization (CME) is a serious complication following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. The use of metoprolol before PCI can significantly protect ischemic myocardium from myocardial damage, but the function of metoprolol in the treatment of CME is not entirely clear. This study was to explore the effect and significance of metoprolol on myocardial apoptosis and caspase-3 activation after CME in rats. METHODS: Thirty rats were randomly divided into three groups including sham-operation (control group), CME plus saline (CME group), CME plus metoprolol (metoprolol group), 10 rats for each group. The CME group was induced by injecting 3000 polyethylene microspheres (42 μm) into the left ventricle during a 10-second occlusion of the ascending aorta; the control group was injected with physiological saline instead of microembolization ball; the metoprolol or saline group was given three intravenous bolus injections before CME. Echocardiography, TUNEL staining, and Western blotting were used to evaluate cardiac function, proportion of apoptotic cells and activation of caspase-3 respectively at 6 hours after operation. RESULTS: Echocardiographic parameters displayed that the metoprolol group improved cardiac function significantly compared with the CME group (P<0.05). The myocardial apoptotic rate of the CME group as wel as the contents of activated caspase-3 increased significantly (P<0.05), both of which were ameliorated significantly by metoprolol treatment (P<0.05). CONCLUSIONS: This study demonstrates that metoprolol can protect the myocardium during CME in rats by inhibiting apoptosis and improving cardiac function. These results suggest that the inhibition of apoptosis can be a potential therapeutic strategy for the treatment of CME.

Background The quantitative analysis of the relationship between the vitreous volume with diopter and axial length in high myopic eye can offer a valuable basis for relevant clinical research. However, how to measure the ocular volume in vivo is a problem. Objective This study was to measure the eyeball volumes with magnetic resonance imaging ( MRI) and compare the difference of ocular volume between emmetropic and high-myopic eyes in order to explore the influent factors of changes of eyeball volumes. Methods The volumes of ocular anterior segment,lens and vitreous were measured using MRI( 1.5-T) in 60 emmetropic eyes and 60 high-myopic eyes. The ocular axial lengths of the subjects were measured by A-scan ultrasonography. The alterations of vitreous volumes with the changes of axial lengths and diopters were evaluated by linear regression analysis. Written informed consent was obtained from each patient before any medical examination. Results The mean diopters of high myopic eyes was ( - 15. 62 ± 8. 27 ) D and the mean axial lengths were ( 28. 68 ± 2. 68 ) mm, showing a significantly positive correlation between them(R2=0. 830,P = 0. 000). The mean total ocular volumes were(7.46±0. 89)ml3 and those of vitreous were ( 6. 90 ± 0. 8 ) ml3 in the high-myopic eyes with a significant increase in comparison with emmetropic eyes [ ( 6. 00 ± 0. 35 ) ml3 and ( 5. 41 ±0. 32 ) ml3 ] ( t = - 11. 846, P = 0. 000; t = - 12. 1, P = 0. 000 ). However,no significant differences were found in the anterior segment volumes and lens volumes between high myopic eyes and emmetropic eyes (t = 1. 23, P = 0. 220; t = -0. 483 , P = 0. 630 ). The vitreous volumes of high myopic eyes were significantly correlated with the diopters and the axial lengths (R2 =0. 75 ,P = 0. 000 ;R2 =0. 85 ,P = 0. 000) ,and so were the total ocular volumes (R2 = 0. 7543, P = 0. 000; R2 = 0. 8413, P = 0. 000). Conclusion The alteration of vitreous volumes is a mainly cause of difference of total ocular volume in ammetropic eyes. In high myopic eye, vitreous volume has a good linear correlation with refractive error and axial length, which may offer valuable information for vitrectomy.