Objective To study the clinical application value of the low forceps in vaginal delivery. Methods To retrospectively analyze the clinical data of 280 cases of the low forceps in vaginal delivery,and randomly selected 140 cases pregnant women who cesarean section, as the control group. To compare the influence of maternal and neonatal morbidity in the two groups. Results There were no statistically significant differences between the two groups for the incidence of the postdelivery hemorrage,birth trauma infectious, asphyxia neonatorum associated with delivery from low forceps when compared with cesarean section. The incidenc of the postdelivery sick rate was significantly lower in the low forceps group( 3.2% ) than that in the control group ( 10.0% ) ( x2 = 8.30, P ＜ 0.05 ). Conclusion Low forceps may be a valuable instrument and safety or efficacy in vaginal delivery and that it should be more widely used in appropriate clinical situations.

Objective To improve the diagnosis and management of closed renal trauma,and to reduce the rate of nephrectomy. Methods A total of 189 cases (146 men and 43 women; mean age,38 years) of closed renal trauma were retrospectively studied. A variety of examinations, including urinary analysis, B-ultrasonography, intravenous urography( IVU) and CT,were used for the diagnosis in these patients. Among them,closed renal trauma was accompanied by celiac viscera injury in 27 cases,by encephalic injury in 5, by fractures of spine and limbs in 13,and by compound trauma and shock in 3. Of the 189 cases, 156 were treated with conservative therapy, including 3 of spleen rupture,2 of encephalic injury,7 of fracture of spine and limbs;27 cases were treated with operation, including 15 with kidney repair,5 with partial nephrectomy, 7 with nephrectomy;3 cases were treated with selective renal artery embolization. Results Three patients with severe closed renal trauma died of compound trauma and shock soon after admission,and the other 186 patients recovered. Of them, 102 cases were followed up from 3 months to 8 years. Among patients undergoing conservative treatment renal hypertension occurred in 3 cases, urinoma in 1 , kidney atrophy in 1 and local hydronephrosis in 1. In patients undergoing surgery or selective kidney artery embolization, no subsequent complication occurred. Conclusions CT scan can provide a major basis for the diagnosis and treatment choice as well as early detection of urinoma of closed renal trauma. For closed renal trauma below grade IV ,conservative treatment is the better option.

Objective To provide clinical experience in the treatment and prevention of complicated acute cardiac tamponade in the course of heart interventional therapy. Methods To analyse the clinical features of patients with acute cardiac tamponade and to investigate the possible underlying mechanism. Results Twenty-one cases experienced acute cardiac tamponade when undergoing heart interventional therapy. Among all the 21 patients with acute cardiac tamponade, 11 occurred from percutaneous coronary interention(PCI) ,6 from the radiofrequency catheter ablation , 1 from the closure of atrial rspetal with amplaty closure service, 1 from the percutaeous balloon mitral valvuloplasty ( PBMV), 2 from temporary pacemaker implantation. Eighteen patients were successfully rescued left no serious sequelae. Three cased died, including two PCI-related death and one temporary-pacemaker-installation-related death. Conclusion Any heart interventional operation is at the risk to cause acute cardiac tamponade. Early identification and appropriate treatment is the key to successful rescue.

Objective To study chemical constituents in the leaves of Acanthopanax gracilistylus.Methods The chemical components were isolated and purified by silica gel,ODS C-18,and Sephadex LH-20 column chromatogram.The chemical structures were elucidated on the basis of physicochemical properties and spectral data.Results Seventeen compounds were isolated and identified as(-)-kaur-16-en-19-oic acid(Ⅰ),quercetin(Ⅱ),kaempferol(Ⅲ),protocatechuic acid(Ⅳ),acankoreoside A(Ⅴ),acantrifoside A(Ⅵ),3?,11?-dihydroxy-20(29)-lupene-23,28-dioic acid(Ⅶ),?-sitosterol(Ⅷ),daucosterol(Ⅸ),palmitic acid(Ⅹ),rutin(Ⅺ),stigmast-5,22-dien-3-O-?-D-glucopyranoside(ⅩⅡ),acankoreagenin(ⅩⅢ),3,11-dihydroxy-23-oxo-20(29)-lupen-28-oic acid(ⅩⅣ),3-hydroxy-23-oxo-20(29)-lupen-28-oic acid(ⅩⅤ),myristin(ⅩⅥ),and acanthopanaxgric acid(ⅩⅦ).Conclusion Compounds Ⅱ-Ⅳ,Ⅶ,Ⅺ,ⅩⅡ,ⅩⅣ,and ⅩⅤ are obtained from the leaves of the plant for the first time and compounds ⅩⅦ is a new proved compound named acanthopanaxgric acid.

Objective By using optical coherence tomography (OCT) to observe the residual subretina fluid changes in fovea that may explain visual recovery after anatomically successful repair of rhegmatogenous retinal detachments (RD). Design Prospective observational case series. Participants 34 patients(35 eyes) with successful retinal reattachment after macula involving RD repair. Methods 34 patients were followed up at 3 days, 15 days, 2 months and 6 months after sclera buckling. The best corrected visual acuity(BCVA), eye fundus status were recorded. The OCT images through the center of the fovea were obtained. Main Outcome Measures The OCT images and BCVA after RD repair. Results The BCVA and OCT images were obtained 3 days to 6 months postoperatively. There were 3 eyes, 5 eyes, 9 eyes and 23 eyes respectively with residual subfovea fluid absorbed totally at 3 days, 15 days, 2 months and 6 months. In the residual subforvea fluid group, the mean visual acuity increased at 0.124?0.013. In the subfovea fluid absorbed group, the mean visual acuity increased at only 0.019?0.006. Conclusions After anatomically successful repair of RD performend with sclera buckling, the minimal residual subforvea fluid will exist for a long time and will be absorbed slowly. This may explain slow increase of postoperative visual acuity after anatomically successful repair.

Objective To evaluate the causes of the metamorphopsia in patients with reattached retina after scleral buckling surgery. Methods Amsler grid test, ophthalmoscopic examination, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed on 79 patients (79 eyes) with reattached retina at the 2nd week, 2nd, 6th month and 1st year after scleral buckling operation. Results Two weeks after the operation, 51 patients (51 eyes, 64.56%) complained of metamorphopsia, and 44 patients (44 eyes, including 35 with and 9 without metamorphopsia) were examined by OCT and FFA. In patients with metamorphopsia, the results of OCT in 31 (88.57%) revealed abnormal macula with seven kinds consisting mostly of stratum neuroepithelium detachment (74.29%), while of FFA in 6 patients showed abnormal macular (17.14%) including 4 with neuroepithelium detachment (66.67%). In patients without metamorphopsia, abnormal macula could be found in 2 by OCT while nothing special was seen in FFA. Most abnormal macula in patients followed-up 2 months, 6 months and 1 year postoperatively meliorated as time went by, with alleviative or disappeared metamorphopsia; while the patients with persistently existing macular membrane had aggravating metamorphopsia. Conclusions Abnormal macula is the main reason for metamorphopsia after scleral buckling surgery. Neuroepithelium detachment and macular membrane are the main causes of metamorphopsia at the early and terminal stage after operation.

Objective To explore the possible functional mechanism of Er-xian Decoction and its component herbs on the expression of extrogen receptor(ER) in adrenal development rats.Methods Fifty-four development female SD rats were randomly divided into nine groups:normal control group(A),positive control group(B),Er-xian Decoction group(C),Herba Epimedii group(D),Rhizoma Curculiginis group(E),Radix Morindae Officinalis group(F),Radix Angelicae Sinensis group(G),Cortex Phellodendri group(H),Rhizoma Anemarrhenae group(I).After the rats were administrated for six days,serum were got to measure testosterone(T).Bilateral adrenal gland was weighed and embedded by paraffin.Mean optical density(MOD) were studied by the immunohistochemical method and image analyzing system.Results The adrenal coefficient was increased in group B and C,and the level of T was decreased in group C,D,E and I.ER? was mainly observed in the cytoplasm of zona glomerulosa and zona fasciculate.MOD in group C was increased while declined in group B.ER? was mainly observed in nucleus of zona glomerulosa and zona fasciculate.MOD in group C,D,E and I was less than group B.Conclusion Er-xian Decoction and its component herbs of warming Shen(Herba Epimedii,Rhizoma Curculiginis) and nourishing Yin(Rhizoma Anemarrhenae) play a phytoestrogen role by influencing the expression of ER? and ER ? in the adrenal cortex.

Objective To evaluate the role of evidence-based nursing in clinical ophthalmology teaching. Methods Fifty nursing interns in department of ophthalmology in Southwest Hospital were randomized into control group and observation group in accordance with the principle of equal number of junior college students and undergraduates. Traditional teaching was applied in control group while clinical ophthalmology teaching combined with traditional teaching was used in observation group. Teaching effect was evaluated at the end of internship by questionnaire and examination. Data were analyzed by SPSS 13.0 using χ2 test and independent sample t test(taking students with score ≥60 as effective indicator). P<0.05 indicated significant difference. Results Scores of questionnaire and examination were higher in observation group than in control group, with statistically significant differ-ence( χ2=6.818, P=0.018). Theoretical exam score was 67.12±11.53 in control group and 84.96± 9.27 in observation group; practical score was 65.68±8.0 in control group and 80.28±10.65 in observation group with significant differences between two groups (P=0.000). Conclusions Adoption of evidence-based nursing intervention in ophthalmic clinical teaching help students learn to think, consult literature and use critical thinking to raise questions during the internship. It also makes stu-dents regard the results of scientific research and personal experience as the basis for mastering pro-fessional and scientific expertise, thereby enhancing the ability of nursing practice.

Objective To investigate the application of evidence-based nursing in the patients with cerebrospinal fluid leakage (CSFL) after vertebrae surgery.Methods 60 cases of patients were randomly divided into the observation group and the control group (30 cases in each),the control group was given conventional nursing,the observation group used evidence-based nursing,which was established by referring to some data and literatures according to a series of related nursing problems,getting direct and indirect evidence,and through analysis and summarizing to set up the nursing project for implementation.The incidence of intracranial hypotension headache,hyponatremia,wound healing disorders,infection of intervertebral space were compared.Results In the observation group,incidence of postoperative intracranial hypotension symptoms,postoperative hyponatremia,the incidence of wound healing disorders was statistically different from that of the control group.The incidence of infection in two groups showed no significant difference.Conclusions Using evidence-based nursing can reduce a series of complications in patients with CSFL after cervical surgery,control infection effectively,improve patients' comfort and improve the quality of nursing.