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 This study was designed to establish an experimental Choroidal neovascularization (CNV) model in BN rats, which could exhibit high reproducibility and to evaluate the expression of pigment epithelium-derived factor (PEDF). Methods 30 rats were received krypton laser. 1 days, 3 days, 7 days, 14days, 21 days and 28 days after photocoagulation, fundus fluorescein angiography (FFA) wAS performed. Total RNA were abstracted from retinal and choroidal tissue and the mRNA of PEDF was detected by RT-PCR.Results FFA showed flurescein leakage from 1 week to 4 weeks after photocoagulation. The mRNA of PEDF were in significantly difference during 4 weeks by RT-PCR.Conclusions Kryton laser photocoagulation can be successfully used to produced CNV experimental model in the BN rat. This study gave us a effective way to evaluate the mechanism of CNV by RT-PCR.

Background and purpose:Pancreatic cancer is one of the most deadly human malignant neoplasms. Resistance to chemotherapeutic drugs is a major reason responsible for poor prognosis in the treatment of pancreatic cancer patients. MicroRNA (miRNA, miR) is a family of small non-coding RNA molecules, dysregulated miRNA is associated with various tumor biological function. miR-33a has been widely reported as a metabolism-related miRNA, while its relationship with drug resistance has little understand. This study was focused on the effect of miR-33a on gemcitabine chemoresistance in pancreatic cancer to bring the novel theoretical basis to chemotherapy for pancreatic cancer.Methods:In situ hybridization and Real-time PCR were used to analyze the miR-33a expressions in pancreatic cancer tissue sample and cell lines, respectively. Cell counting kit 8 (CCK-8) assay was used to calculate the IC50 value of different pancreatic cancer cells.Results:miR-33a was down-regulated in pancreatic cancer tissue and cell lines compared with para-cancerous tissues and normal HEK293T cells. Moreover, miR-33a over expression not only could enhance the chemosensitivity to gemcitabine in pancreatic cancer cells, but also rescue the gemcitabine resistance in pancreatic cancer cells.Conclusion:Down regulation of miR-33a in pancreatic cancer decreases the chemosensitivity to gemcitabine, resulting in development of acquired gemcitabine chemoresistance. It provides the theoretical basis to develop a new molecular targeted drug to combine with chemotherapy for pancreatic cancer.

Objective To compare the safety and effect of the phacoemulsification (PHACO) versus extracapsular cataract extraction (ECCE) in patients with intumescent senile cataract.Methods 200 eyes from patients with intumescent cataract were included and randomly divided into 2 groups:PE group (108 eyes,received PHACO) and ECCE group (92 eyes,received small incision ECCE) respectively.Superior quadrant sclera tunnel incisions were made with stabs of 2.8 mm diameters.Trypan-blue was used to show the anterior lens capsular membrane.In the PHACO group,a 4 mm diameters continuous curvilinear capsulorhexis (CCC) was made,which was enlarged to 6-7 mm after the intraocular lenses (IOL) implantation.For the ECCE group,a 8 mm-diameter CCC was made.Then the lens nucleus was either phacoemulsificated or delivered and IOL was implanted.The complications during and after surgery and the visual outcomes were recorded and statistically analyzed by SPSS 13.0 software.Results Age,sex and the hardness of the nucleus were comparable between the two groups.The best corrected vision acuity (BCVA) was 0.05 and worse in all patients before surgery.While 3 days after operation,in PE group,105 eyes (97.2％,105/108) gained postoperative vision 0.05 and better,and 82 of them were better than 0.3; in group ECCE,97.2％ (89/92) of the operated eyes gained vision 0.05 and better,72 (78.3％,72/92) eyes were better than 0.3.No statistical differences were found between the two groups in postoperative vision recovery.While,there were more failure rates of the CCC,tear of the anterior and posterior capsular,loss of the vitreous and iris injury rate in the ECCE group than in the PE group (20.7％ vs.8.3％,17.4％ vs.12.0％,7.6％ vs.0.9％,15.2％ vs.0％,P=0.01,P=0.00,P=0.02,P＜ 0.001).Prolapse of iris and discoria were found in ECCE group.Conclusions With small CCC,phacoemulsification can lead to better surgical outcomes than small incision ECCE procedures,and the operative and post-operative complications are less in PE group than in ECCE group.

Objective:To explore the effects of quality control circle(QCC) on the complaint management and patient satisfaction in the medical insurance center.Methods:We set up QCC,defined the subject,identified the problems and made the cause analysis,made the countermeasures and implemented them.Results:Mter QCC ac-tivities,patients'major unsatisfactory factors such as long waiting time and poor staff coordination ability were signif-icantly improved.In addition,patient complaints decreased significantly (P ＜ 0.01).Conclusion:The application of QCC management on patient complaints can not only increase patient satisfaction,but also provide an importantway for the hospital to build up the brand.

Objective To investigate clinical characteristics,diagnosis,treatment and prognosis of mucormycosis in patients with renal failure. Methods We reported a 65-year old case of mucormycosis with chronic renal failure. The patient was successfully treated with amphotericin B. Mucormycosis complicated with renal failure were reviewed excluding mucormycosis peritonitis associated with peritoneal dialysis and desferrioxamine-related mucormycosis. Results Fifteen cases including our case were involved with mean age of 49.87?15.84 years old. Rhinocerebral,pulmonary,and disseminated forms accounted for 46.7%,33.3% and 20% respectively. Autopsy was made in 46.7% of patients. Mortality was 73.3% in all of them and 42.9% in seven patients who received antifungal therapy. All patients without treatments died. Conclusion Mucormycosis is a lethal invasive infection in patients with renal failure. The management to improve prognosis are early diagnosis,surgical debridement,drainage and aggressive antifungal chemo-therapy.

ObjectiveTo investigate the experience of resection of superior sulcus tumors using the improved antero-cervical parastemal approach.MethodsThe clinical data of 3 patients with superior sulcus tumor from July 2005 to May 2010 were analyzed retrospectively.Three patients with superior sulcus tumor underwent en bloc resection using the improved antero-cervical parastemal approach.The 1st to 3rd rib were excised,1 case with 1/5 centrum vertebra excision,1 case with the 1st transverse process of thoracic vertebra excision,1 case with the 1 st and 2nd transverse process of thoracic vertebra excision,1 case with T1 nerve root and sellate ganglion excision.ResultsAll the patients recovered well after operation.There was no serious complication except for 1 case with secondary Horner syndrome.The mild paradoxicalbreathing was found in 3 cases postoperative dressing change,but they had no dyspnea and tolerance well.The paradoxical breathing was disappeared when the mediastinum was fixed after 14 d thoracic wall pressure dressing.The pathological diagnosis after operation:2 cases with squamous-celled carcinoma,1 case with adenosquamous carcinoma,there was no mediastinal lymph node metastasis,cutting edge was negative.Stage:2 cases with T3N0M0,1 case with T4N0M0.Three cases were treated with chemotherapy (NP plan) for 4 cycles after operation without radiotherapy.Three cases were followed up for 53,37, 13 months after operation,they were all survival without recurrence and good quality life.ConclusionsFor the treatment of especially anterior and middle seated superior sulcus tumors,improved antero-cervical parasternal approach provides a safe and effective exposure.The improved antero-cervical parasternal approach is worthy of promotion.

10.3969/j.issn.1007-3969.2013.05.001

10.3969/j.issn.1007-3969.2013.04.004