Clinical ophthalmic surgery is a special branch of general surgery,the microsurgery of ophthalmology has properties of high-precision,high-risk and longer learning curve.The ophthalmology department of Tongji University Hospital has explored a set of step-by-step and efficacious postgraduate student education method,including theoretical basis,in vitro stimulation and in vivo practice.The intervention of quality control and incentive mechanism were also included.

Objective To observe the clinical effects of a new method:non-optic nerve transecring evisceration combined with first stage hydroxyapatite orbital implantation.Methods One hundred and twenty two eyes (122 cases) were randomly divided into group A and group B,evisceration was first undertaken,the scleral wall was superior-temporally to inferior-nasally dissected and double scleral petals were placed before the implanted hydroxyapatite artificial eyeball.The difference between group A and group B was:in group A,the optic nerve was transected behind the eyeball,but in group B,a 2 mm outside the optic nerve scleral circle cutting was taken.Hemostasis time before implantation,tensile force during conjunctival suture,pain during surgery,palpebral fissure height after eye speculum wearing,operation time consuming,pain after surgery,conjunctival edema and congestion,and ocular prosthesis wearing time were compared between the two groups.Results In groups A and B,the intra-operative hemostasis time were (23.46 ± 6.96)mins and (5.49 ± 1.72)mins,the tensile force score during conjunctiva suture were 3.39±0.74 and 0.45±0.59,the score of pain in the first day were 2.8 ±0.68 and 1.47 ± 0.67,the ocular prosthesis wearing time after surgery were (6.27±2.73) and (3.07 ± 2.11)weeks,respectively.The differences of all the parameters above were with statistical significance between groups A and B (P＜0.01).During 2 years follow-up,no complications such as orbital implant exposure or infection happened.Conclusions Compared to traditional methods,the non-optic nerve transecting evisceration method has merits of less impairment,short time-consuming,less pain,and quicker postoperative recovery.

BACKGROUND:Comeal graft endothelial cell density may decline spontaneously at a super-physiological speed after penetrating keratoplasty (PKP),even if no corneal rejection happens,and this is chronic corneal allograff dysfunction (CCAD).OBJECTIVE:To investigate the effects of topical corticosteroid treatment on chronic corneal allograft dysfunction after PKP.DESIGN,TIME AND SETTING:A controlled clinical analysis was performed at the Department of Ophthalmology,Tongji Hospital,Tongji University from May 2004 to May 2009.PARTICIPANTS:A total of 54 patients (eyes) who underwent PKP were included in this study.METHODS:Tobramycin-dexamethasone eyedrops was applied 6 times per day as an initial dosage and tapered during 4 months.Thereafter,drug withdrawal group and long term group were randomly divided.Treatments were ceased in the drug withdrawal group but were continued in the long-term group with a dosage of twice per day till 12 months after surgery.MAIN OUTCOME MEASURES:Corneal graft endothelial cell density was followed up.The mean follow up pedod was 3.12±0.28years.RESULTS:The corneal graft endothelial cell density of drug withdrawal and long term groups was dramatically declined within 36 months after PKP.At every time point,the endothelial cell density was significantly decreased compared to the last follow up (all P＜0.01 ).The endothelial cell density was decreased from (2 428±2.11) cells/mm~2 and (2 791±2.29) cells/mm~2 to (1 424±124) cells/mm~2 and (1 614±114) cells/mm~2 in the drug withdrawal and long-term groups,respectively.There was significant difference in endothelial cell density between the two groups no matter prior to surgery or at each time points after surgery,but the declination trends of two groups were basically the same,indicating that graft loss of endothelial cell density was not impacted by topical corticosteroid treatment after PKP (P＞0.05).CONCLUSION:Chronic corneal allograft dysfunction after PKP is independent of topical corticosteroid treatment.

The clinical features of 17 patients with benign urachal masses and 30 patients with urachal carcinoma treated at Sun Yat-sen University Cancer Center were analyzed retrospectively.Univariate analysis indicated that seven parameters differed significantly between the two groups.Binary logistic regression analyses showed that the rate of gross hematuria was significantly higher (P =0.042,Exp[B] =7.889) and the rate of fatty infiltration of the Retzius space was significantly lower (P =0.006,Exp[B] =0.028) in patients with urachal carcinoma than in those with benign urachal masses.Gross hematuria and fatty infiltration of the Retzius space may be indications of malignant and benign urachal masses,respectively.

Objective To study the training methods of equipments for the national medical rescue team,for the purpose of enhanced equipment operation ability of team members and enhanced overall capacity for emergency rescue.Methods Using such methods as investigation and discussion,procedures development,examination standards development,and training and examination.These methods are designed to improve the equipment training methods for the national medical rescue team.Results Following the training,get-ready time of the whole team is cut back from 200 minutes to 90 minutes,and the roll-up time from 170 minutes to 80 minutes.Number of equipments mastered by the whole team has risen from 147 pcs/sets(47.2 ％) to 290 pcs/sets(94.5 ％),while average number of equipments mastered per person has risen from 98 pcs/sets(31.9％) to 185 pcs/sets(60.3％).Conclusion The Equipment Operation Procedures List and Equipment Training and Examination Standards should be made in consideration of the development needs of a national medical rescue team and disaster rescue experiences.In addition,such trainings and examinations as those by means of whole team,groups,and group-section crossing can improve the emergency rescue capabilities of the national medical rescue team.

Objective To exclude false positivities in detection of IgM antibodies against hepatitis E vires of genotype 4 (HEV-4) using a truncated immunodominant polypeptide of HEV open reading frames (ORF2). Methods The recombinant ORF2 immunodominant polypeptide corresponding to amino acids (AA) 459-607 and a truncated polypeptide corresponding to AA 472-607 were separately applied to coat ELISA plates. Anti-HEV IgM from 35 serum samples with HEV RNA positive, 69 serum samples from healthy individuals and 117 clinically suspicious HEV RNA positive serum samples was detected by an indirect ELISA and was confirmed by western blot in protein level and RT-PCR detecting in RNA level. Results Western blot analysis showed that the sera from HEV patients reacted with the dimmer of peptide 459-607, but they didn't react with the monomer and peptide 472-607. The ELISA showed that all 35 serum HEV RNA positive samples reacted with peptide 459-607 but not with peptide 472-607 and none of the 69 serum samples from healthy individuals reacted with either polypeptide. Among 117 chnically suspicious HEV RNA serum samples, 5 samples reacted simultaneously with both polypeptides. But the difference between 450 nm absorbance (A450) value was less than 0. 5. Western blot analysis demonstrated that all the 5 serum samples were anti-HEV IgM- negative. The 5 serum samples was detected negative by RT-PCR, indicating that the false pesitivities were caused by non-specific absorption. Conclusions ORF2 peptide 459-607 may be used to detect anti-HEV lgM efficiently. The false positivities caused by non-specific absorption can be largely excluded according to the difference between 45Ohm absorbance (A450) value when serum reacts with both polypeptides.

Objective To investigate the expression of XIAP, Smac, HtrA2 and XAF1 in the hippocampus following SE in rats and to explore the pathophysiological mechanisms of expression of XIAP and its negative regulators after SE. Methods The lithium-pilocapine model of status epilepticus was established in SD rat. XIAP, Smac, HtrA2, XAF1 and activated caspase-3 protein were examined using immunohistochemistry. Western blot was used to detect the protein levels of XIAP, Smac, HtrA2 and activated easpase-3. Results XIAP immunoreactivity diffusely distributed within the neuron after SE. Compared with the control group, the expression of CA3 XIAP protein in the SE group was increased gradually since 2 hours (0.5503±0.0172 vs 0.1507±0.0165, t=115.87, P<0.01), peaking at 8 hours (0.6221±0.0238 vs 0.1507±0.0165, t=136.69, P<0.01). The expression of CA3 Smac, HtrA2, XAF1 and activated caspase-3 protein were increased generally following SE. Western blot analysis showed a significant increase in Stoat, HtrA2, activated caspase-3 protein levels from 2 to 72 hours following SE, but no significant differences were seen in XIAP protein levels between the control group and the SE group. Conclusions The XIAP, Smac, HtrA2 and XAF1 are involved in the regulation of neuronal apoptosis and implicated in pathophysiological mechanisms of neuronal damage after SE.

OBJECTIVE: To study the bioequivalence of tegaserod maleate dispersible tablets in healthy volunteers.METHODS: A single oral dose of 6mg test or reference preparations of tegaserod maleate was given to 22 healthy volunteers in a randomized crossover study.The plasma concentrations of tegaserod were determined by LC/MS/MS assay.RESULTS: The main pharmacokinetic parameters of test and reference products were as follows: tmax(0.86? 0.22) and(1. 01? 0.24) h;Cmax(2.21? 0.69) and(2.05? 0.64) ng? mL1;AUC0～ 17(6.35? 2.48) and(6.47? 1.99) ng? h? mL-1,AUC0～ ∞(6.69? 2.59) and(6.70? 2.03) ng? h? mL-1,respectively.The relative bioavailability of test to reference preparation was(98.2? 22.1) %.CONCLUSION: The reference preparation and the test preparation are bioequivalent.

In order to train the clinical ophthalmic seven-year students to further comprehend their professional knowledge and further stimulate their imagination and creation ability, we developed several steps to promote these students' patent designing ability. These steps include: trained targets selection, theoretical knowledge training, clinical practice training, comprehensive quality control, et al. In the implementation of the concrete steps, we put emphasis on the elements such as step by step training, the high quality computer assisted mapping and the internationally compatible contents, et al., and encouraged the students to propose the assumption of solving the problems in the clinical and sci-entific research. And the stimulation mechanism and medical humanity were infiltrated all the while.

Aim: To establish a simple and convenient quality evaluation method for Fructus Gardeniae(FG).Methods: The internal standard correction factors(f_(km))of four crocetin derivatives to crocin-1 were established and the system suitability was tested.The content of crocin-1 was determined by external standard method,the contents of other crocetin derivatives were calculated by the content of crocin-1 and their f_(km).Results: There was no significant difference between the test results obtained by the methods oftheoretical calculation by f_(km)androutire determination technique.Conclusion: The internal standard correction method(the method oftheoreti-cal calculation by f_(km))is practical and feasible in the quantitative analysis of Frnctus Gardeniae.