we examined the serum copper level in 125 pregnant women (83) normal pregnant women of 28～40 weeks of pregnancy; 12 patients with se-vere edema-proteinurine-hyperterision syndromeduring 37～40 weeks of pregnancy; 30 patientswith prolonged pregnancy) and compared it withurine E/C value and Apgar score in order to deter-mine the reliability of serum copper value in diag-nosing placental insufficiency. The results con-firmed that the serum copper value was increasingwith the growth of weeks of pregnancy, but it wasdecreasing after the fortieth week of pregnancy.Comparison of the serum copper value with theurine E/C value showed that when the E/C or = 10. And when the Apgar score7. These results indicatethat the serum copper value can serve as an indexof placental function in the third trimester of preg-nancy.

Objective:To evaluate the preventive effect of proximal splenic vein ligation after splenectomy on the splenic vein originated portal vein thrombosis (PVT) in portal hypertension.Methods:The clinical data of 94 patients of portal hypertension who had received splenectomy were retrospectively analysed. The proximal splenic vein was ligated in 36 cases during pericardial devascularization and coronary renal shunt with splenectomy. The other 58 cases who had received pericardial devascularization without proximal splenic vein ligation served as control. All of the patients in both groups were given heparin infusion postoperatively through the catheter which was placed in the right gastroepiploic vein during operation. CT portal veinography was performed at the 7th-14th postoperative day for detection of PVT.Results:None of the PVT occurred in the splenic vein ligation group. In the control group, PVT occurred in 22 cases(38%) and splenic vein thrombosis occurred in all the 58 cases (100%). PVT incidence between the two groups is significantly different (0 vs. 38%, χ 2=17.828, P<0.05). Conclusions:Ligation of the proximal splenic vein during splenectomy can effectively prevent the postoperative splenic vein originated PVT in portal hypertension.

BACKGROUND:The most advanced and representative diagnosis techniques for perforating branch of blood vessels include digital subtraction angiography, CT, MRI and other imaging techniques. These methods can visualize blood vessels clearly and have a high precision, but there are some trauma and less popular.
OBJECTIVE:To apply high-frequency ultrasound for detection of thoracic dorsal artery and perforating branch, and provide a reference for preoperative design of thoracic dorsal artery perforating flap.
METHODFifteen patients candidate for thoracic dorsal artery perforating flap were included in this study. Before surgery, we used high-frequency ultrasound to detect the perforating branch, including vascular contorts, diameter, the location of the perforators and surface markers. The thick, superficial, paral el perforating branch was selected as the main blood vessels, to design and cur the skin flap.
RESULTS AND CONCLUSION:In the involved 15 cases, thoracic dorsal artery were derived from the subscapular artery, thoracic dorsal artery and its main branches, as wel as more than 1 mm main perforating branch in 13 cases were clearly visible. It was consistent with intraoperative measurement results. The perforating branch less than 1 mm only showed strip-like blood flow signal or no blood flow and spectrum signal, and there was an unclear boundary to surrounding tissue. One case appeared distortion and variation of blood vessels before surgery, thus changed to other surgery. Two cases had no perforating branch by preoperative detection, which was then confirmed by intraoperative anatomy. High-frequency ultrasound has a significant effect on preoperative position of perforating branch, and the combination with computer tomography angiography and magnetic resonance angiography can support a more comprehensive and reliable reference.

Medical ethics is the standard ofbehavior toadjust the relationship between medical personnel and patients,medical personnel,medical personnel and society.It is a general social morality in medical field in special performance.Teachers should carry through the ethics education to the end,making students smoothly enter society from the school,cultivating good ethics during the process of learning basic knowledge of oral cavity,and developing high-quality oral physicians for our country.

Objective To investigate the efficacy and feasibility of combination of leflunomide and clopi-dogrel in the treatment of IgA nephropathy. Methods 84 patients with primary IgA nephropathy were randomly divided into four groups: Control group (group 1) received valsartan; test group (group 2) received valsartan +clopidogrel; group 3 received valsartan + leflunomide; group 4 received valsartan + clopidogrel + leflunomide. The level of 24 h urinary protein,serum creatinine, glomerular filtration rate and therapeutic efficacy, adverse reactions were detected and recorded during the 48 weeks follow-up. Results The 24 h urinary protein of 84 patients showed a downward trend during the course of treatment , but there were statistical differences between groups since 8 weeks after treatment (P < 0.05). The level of urine protein in group 3 and group 4 decreased significantly to 61.48% and 67.23% respectively in 48 weeks after treatment. At the end of the follow up , the serum creatinine levels in group 1 and group 2 significantly increased while the glomerular filtration rate de-creased obviously (P < 0.05). Conclusion The combination of leflunomide with clopidogrel could reduce the level of urinary proteins and slow renal function deterioration in the treatment of IgA nephropathy with less ad-verse reactions. This study provides a new idea for treatment of IgA nephropathy.

OBJECTIVETo explore the therapeutic alternatives and evaluate the related clinical results of patients with primary central nervous system lymphoma (PCNSL) treated with gamma knife radiosurgery (GKS).

METHODSFrom January 1995 to December 2001, 44 patients suffering from PCNSL, who had undergone stereotactic biopsy or craniotomy, and who had received a confirmed diagnosis through pathological examination, were treated with GKS. All cases were followed up for 1 - 46 months with an average postoperative period of 27 months. The clinical materials, image features, treatment methods and results of follow-up, were retrospectively reviewed.

RESULTSThe symptoms and signs of the patients were markedly improved within 1 - 3 weeks after GKS. The Kanofsky performance status was also improved from a preoperative average of 40% to a postoperative one of 90%. Thirty-eight patients (86.36%) were in complete remission (CR), the other six (13.63%) were in partial remission (PR). The local control rate reached 100%, and the median survival time was 26.5 months. The main side effect was brain edema, which can be treated with dexamethasone and mannitol.

CONCLUSIONGKS is a safe and effective method in multimodality treatment of PCNSL. A stereotactic biopsy coupled with GKS is the first choice for diagnosis and treatment. Adjuvant chemotherapy or radiotherapy should then be given according to the patient's condition.

Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms ; surgery ; Combined Modality Therapy ; Female ; Humans ; Lymphoma ; surgery ; Male ; Middle Aged ; Radiosurgery ; Retrospective Studies ; Treatment Outcome

Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique (the mono-ring culotte) stenting was done in which the side branch (SB) stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch (MB) wire. Secondly, the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015, 15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was (34. 3 ± 9. 6) min, fluoroscopic time was (18. 1 ± 3. 8) min, and contrast volume was (112. 0 ± 24. 5) ml, respectively. Post-procedurally, the residual stenosis of the main and the side branch were (10. 0 ± 2. 5)% and (10. 2 ± 5. 3)% , respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions, and may be superior to the conventional culotte stenting.

Objective:To investigate the influence of long-term wear of soft contact lenses on corneal transparency.Methods:A cross-sectional study was conducted.The corneal optical density of female myopic patients who planned to undergo corneal refractive surgery in Jinan Mingshui Eye Hospital from January 2018 to December 2020 was examined.The patients were divided into ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group according to the duration of wearing contact lenses.Age- and sex-matched patients without wearing soft contact lenses were enrolled as a control group.There were 50 eyes from 50 cases in each group.The cornea was divided into 0-2, 2-6, 6-10, and 10-12 mm corneal vertex-centered annuli.The cornea over each annulus was divided into a superficial layer (≤120 μm from the outer surface of the cornea), a deep layer (≤60 μm from the inner surface of the cornea) and a central layer (between the superficial and deep layers). Measurements of the right eye were taken for analysis.The corneal optical density of different layers over different corneal ring regions was compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Jinan Mingshui Eye Hospital (No.2018-005). Written informed consent was obtained from each subject before any medical examination.Results:The corneal optical density tended to decrease as the wearing duration of corneal contact lens extended.The corneal optical density values of control group, ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group were 18.51±1.79, 18.25±2.10, 18.16±1.89 and 17.83±1.65, respectively, showing no significant difference ( F=1.152, P=0.329). There was no significant difference in the corneal optical density of the superficial layer over 0-2, 2-6, and 6-10 mm annuli among the four groups ( F=2.077, 2.080, 2.229; all at P>0.05). There was a significant difference in the corneal optical density of the superficial layer over 10-12 mm annulus among the four groups ( F=5.016, P=0.002), and the corneal optical density of the superficial layer was greater in ≥5-<10 years group than in ≥2-<5 years, and greater in ≥10 years group than in control group, showing statistically significant differences (both at P<0.05). There were significant differences in the corneal optical density of the central layer over 0-2 and 6-10 mm annuli ( F=3.808, 2.813; both at P<0.05), and the corneal optical density of the central layer was lower in ≥10 years group than in control group, showing a statistically significant difference ( P<0.05). There were significant differences in the corneal optical density of the deep layer over 0-2, 2-6, 6-10 and 10-12 mm annuli ( F=5.485, 5.625, 3.398, 2.775; all at P<0.05). The optical density of the deep layer was lower in ≥5-<10 years than in control and ≥2-<5 years groups over 0-2, 2-6, and 10-12 mm annuli, lower in ≥5-<10 years group than in control group over the 6-10 annulus, and lower in ≥10 years group than in control group over 0-2, 2-6, and 6-10 mm annuli, and the differences were statistically significant (all at P<0.05). Conclusions:For women, the long-term wear of soft contact lenses for 5 years does not affect corneal transparency, and long-term wear for more than 5 years can cause a decrease in the transparency of the superficial peripheral cornea.

Objective To explore the effectiveness of fast-track surgery ( FTS) in perioperative nursing of patients with percutaneous nephrolithotomy lithotomy with upper-pole access (PCNL).Methods Seventy-six kidney stone ( KS) patients with PCNL in our hospital from November 2011 to December 2013 were chosen and randomly divided into the control group and the intervention group , each with 38 cases.The control group received the routine nursing , and the intervention group received the FTS nursing intervention .The hospital stays, the costs of treatment , the score of BI index of living scale and the incidence of complication were recorded and the patients ’ satisfaction were investigated at the end of nursing in two groups .Results The hospital stays, the costs of treatment, the score of BI index of living scale were respectively (8.8 ±2.3) d, (10 980.6 ±966.3)yuan and (84.6 ±9.4) in the intervention group, and were better than (12.4 ±3.0)d, (14 315.3 ±1 537.3) yuan and (68.9 ±7.3) in the control group, and the differences were statistically significant (t =4.682, 9.473, 6.741, respectively;P <0.05).The incidence rate of complication in the intervention group was 10.5% including 2 cases of postoperative fever and 2 cases of postoperative pain , and was better than 31.6% including 4 cases of severe bleeding , 6 cases of postoperative fever , and 2 cases of postoperative pain in the control group , and the difference was statistically significant (χ2 =5.067, P<0.05). The patients’ satisfaction was 94.7%in the intervention group, and was high than 78.9%in the control group, and the difference was statistically significant (χ2 =4.145,P<0.05).Conclusions FTS nursing intervention adopted in KS patients with PCNL during perioperative period can effectively reduce the incidence of complications , and be accepted by the patients , and which is worthy of further promotion in clinical practice .

Objective To find out the efficacy of postoperative care of patients with non-muscle invasive bladder transitional cell carcinoma and to provide effective interventions for the treatment and rehabilitation of patients after surgery .Methods 109 patients with non-muscle invasive bladder transitional cell carcinoma were randomly divided into the observation group (59 cases) and the control group (50 cases).The control group was cared with the measures included postoperative general nursing intervention , bladder irrigation, intravesical chemotherapy , postoperative complication nursing .Based on these nursing interventions , the observation group was treated with integrated care measures .Patients’ quality of life, mental state and depression were assessed by the Short Form 36 ( SF-36 ) , Self-rating Anxiety Scale ( SAS ) and Self-rating Depression Scale ( SDS), respectively.Nursing satisfaction was investigated by self-made questionnaire. Results Two groups of patients were successfully operated .The postoperative follow-up period was ( 26 .1 ±7.8) months.Recurrence rate of the observation group and the control group were 20.3%(12/59) and 18.0%(9/50), respectively, showed no significant difference (χ2 =1.237,P>0.05).Postoperative incidence of adverse events of observation group and the control group were 25.4% (15/59) and 30.0% (15/50), respectively, showed no significant difference (χ2 =2.301,P>0.05).The SF-36 scores of TH, RP, MH, VT, RE, SF for the observation group were significantly higher ( t =4.596,5.028,5.137,5.918,7.009, 6.402, respectively;P<0.05) than those in the control group .After integrated care measures , the SDS and SAS scores of both groups were significantly lower than before (t=5.891,4.013, respectively;P<0.05).And the SDS and SAS scores in the observation group were significantly lower than those in the control group ( t=3.815,4.202, respectively;P<0.05).Satisfaction with nursing for the observation group was 93.2%(55/59) and 72.0% (36/50) for the control group.There was a significant difference (U =4.716,P <0.05). Conclusions Integrated care measures can effectively improve the quality of life , mental status, and nursing satisfaction of patients with non-muscle invasive bladder transitional cell carcinoma after surgery .