Bilateral sequential cataract surgery is very common in clinical,but the ophthalmologists often ignore how to choose the timing of operation and whether the first eye can be used to improve the intraocular lens (IOL) power calculation for the second one.Despite the refinements in IOL selection with the use of third-generation IOL formulas,5％ of eyes still result in a postoperative refractive surprise of ± 1.00 D or more.This paper introduced the methods of using refraction error of the first eye to improve the IOL power calculation for the second eye,and the refractive error of the second eye can be improved by modifying the IOL power to correct up to 50％ of the error from the first eye in details.Because of the variation of the postoperative refractive surprise within a month,the interval of three to four weeks between two eyes cataract surgery is highly recommended.These conclusions may provide the advantageous guidance for us in the selection of IOL in bilateral cataract surgery.

0.05) except for 8 kHz. Air conduction thresholds were basically normal in children's simple type CSOM, whereas hearing loss during intermediate frequency and high frequency in adults with osteitis and cholesteatoma type was more severe than that in children.Conclusion Hearing-loss in children's CSOM was the same as adult patients, although course of disease was not long in children. Inner ear was not or mildly impaired in children's CSOM.

Objective: To investigate the influence of pharmaceutical care pathway on cancer-related fatigue (CRF) and negative emotion in patients with advanced lung cancer undergoing chemotherapy. Methods: Patients with advanced lung cancer admitted to the oncology department of Yongkang first people′s hospital from January 2017 to June 2018 for chemotherapy were randomly divided into two groups:61 cases received conventional clinical pathway management (control group), and 64 cases received conventional clinical pathway combined with pharmaceutical pathway management (intervention group). Fatigue, anxiety, depression scores were compared between the two groups before and after 2, 4 cycles chemotherapy. Results: There was no significant difference in baseline condition between the two groups (P>0.05). After 4 cycles of chemotherapy, emotional, physical and cognitive fatigue scores in the intervention group were lower than control group (t=2.975, 1.512, 2.393, P<0.05). With the increase of chemotherapy cycles, scores of fatigue dimensions in control group were increased (F=44.274,21.740,29.261,7.206, P<0.05). In the intervention group, there were statistically significant differences in scores of fatigue dimensions (F=17.083, 15.902, 17.055, 10.543, P<0.01), among which, scores of behavioral and physical fatigue dimensions were increased (P<0.01), while scores of emotional and cognitive fatigue dimensions were decreased (P<0.01). In terms of negative emotions, depression scores in the intervention group were lower than those in control group at 2 cycles of chemotherapy (t=2.578, P<0.05), and at 4 cycles, anxiety and depression scores were lower than control group (t=7.004, 7.454, P<0.05). As the chemotherapy cycle increased, anxiety and depression scores in the control group increased (F=12.333, 14.819, P<0.05), while those in the intervention group decreased (F=4.992, 3.826, P<0.05). Conclusion The pathway of clinical pharmaceutical care can significantly improve the CRF and negative emotions of patients with advanced lung cancer undergoing chemotherapy.

Objective: To explore the causes of vascular crisis caused by replantation of severed finger, and summarize the experience of prevention and treatment. Methods: From April 2015 to February 2017, 108 patients with wounded finger treated in the First People's Hospital of Yongkang were divided into two groups according to the occurrence of postoperative vascular crisis situation: the control group (56 cases, vascular risk), the observation group (52 cases, vascular crisis happened). The clinical data of all patients were collected, the various data were compared, and the causes of vascular crisis were analyzed.The observation group was given low molecular dextran treatment, the changes of blood coagulation function indicators before and after treatment were observed. Results: The age, disconnection plane, ischemia time had statistically significant differences between the two groups(all P<0.05). After treatment, the four coagulation function index in the observation group [fiber protease: (3.32±0.29)g/L, activated partial thrombin time: (27.56±2.08)s, thrombin time: (12.13±1.62)s, prothrombin time: (11.47±1.29)s] were improved obviously (t=4.86, 8.63, 6.04, 4.70, all P<0.05). Conclusion The age, disconnection plane and ischemic time are the factors that cause vascular crisis.In addition, postoperative pain, patients' mood, postoperative posture and other factors may also lead to vascular crisis.Preoperative assessment of the condition should be done well, postoperative monitoring should be strengthened, and prophylactic medication can be used to prevent vascular crisis.

Objective: To compare the analgesic effect of ultrasound-guided femoral nerve block and iliofascial lacuna block after total knee arthroplasty. Methods: From June 2016 to June 2018, 96 patients with total knee replacement in Orthopaedic Hospital of Yongkang were selected in this research and divided into two groups by random number table method, with 48 cases in each group.The control group was treated with ultrasound-guided femoral nerve block, and the observation group was treated with ultrasound-guided iliofascial lacuna block.Visual analogue (VAS) pain score, puncture injection time, cumulative fentanyl dosage, recovery time, effective analgesia time, active joint flexion angle and adverse reactions of the affected limb were compared between the two groups at 4 h, 8 h, 12 h, 24 h and 48 h after surgery. Results: There were no statistically significant differences in VAS score at each postoperative time point between the two groups (all P>0.05). At 4 h, 8 h, 12 h and 24 h after surgery, the VAS scores in the observation group [(2.16±0.58) points, (2.03±0.52) points, (1.94±0.47) points, (1.86±0.51) points] were significantly lower than those in the control group [(2.55±0.63) points, (2.46±0.61) points, (2.31±0.55) points, (2.17±0.58) points] (all P<0.05). The time of puncture injection and the cumulative dose of fentanyl were compared between the two groups.The time of puncture injection in the observation group [(2.61±0.41) min] was shorter than that in the control group [(4.20±0.61) min], and the difference was statistically significant (P<0.05). The cumulative dosage of fentanyl in the observation group [(0.51±0.02) mg] was less than that in the control group [(0.68±0.04) mg], and the difference between the two groups was statistically significant (P<0.05). There was no statistically significant difference in anesthesia recovery time between the two groups(P>0.05). The effective analgesic time, limb active joint flexion angle at 24 h, 48 h after operation in the observation group[(39.17±3.52)h, (47.99±4.78)°, (68.97±4.13)°] were significantly higher than those in the control group[(27.34±1.23)h, (30.12±4.68)°, (45.52±3.87)°], the differences were statistically significant (all P<0.05). After treatment, all patients had complications such as nausea and vomiting, pruritus, and hematoma at the puncture point.The total incidence of the observation group(4.17%) was lower than that of the control group (16.67%), the difference was statistically significant (χ²=4.019, P<0.05). Conclusion Ultrasound-guided iliac fascial space block analgesia is significantly better than femoral nerve block in total knee replacement patients, which can effectively reduce pain and adverse reactions.

OBJECTIVE To analyze the cause,clinical characteristic and preventive measures in nosocomial infection of multiple sites. METHODS A total of 123 cases of nosocomial infection in multiple sites in our hospital in 2004 were prospectively monitored and analyzed retrospectively. RESULTS Among 1645 cases of nosocomial infection,123 cases suffered from nosocomial infection in multiple sites.The main infection sites were lower respiratory tract and urinary tract.The main risk factors were over usage of broad-spectrum antibiotics and invasive operation.The serious result was prolongation of duration in hospital,increase in mortality and expensiveness. CONCLUSIONS The nosocomial infection in multiple sites is a main object to be monitored.To prevent,discover and control nosocomial infection in time is an effective measure to reduce the risk of nosocomial infection.

OBJECTIVE To analyze the condition of nosocomical systemic fungus infection and make preventive and control measures against nosocomial systemic fungus infection.METHODS The 496 fungus-cultured positive cases with average age of 61.04 years old among the discharged patients from Jan 2003 to Dec 2005 were reviewed and analyzed.RESULTS The rate of nosocomical systemic fungus infection was 0.53%,from which the over 60 age senile patients accounted for 63.1%.Lower respiratory tract and urinary tract were the most frequent infection sites.The Candida albicans was accounted for 70.71%.The death rate of patients with nosocomial systemic fungus infection was 27.82%.The major correlated factors of nosocomial systemic fungus infection were the widespread use of broad-spectrum antibiotics and not be standardized and the iatrojenic injury of respiratory and urological tracts.CONCLUSIONS The causes of nosocomial systemic fungus infection are closely related to medical treatment;the death rate of patients with nosocomial systemic fungus infection is obvious higher than that without it;to prevent and control nosocomial systemic fungus infection is the key point of nosocomial treatment.

ObjectiveTo evaluate the breast-conserving surgery for early breast cancer.MethodFrom 1993 to 2000, 86 female cases of stage ⅠⅡa breast cancer received breast conserving comprehensive therapy. Clinical data were analyzed retrospectively. ResultsThe 5 year survival rate of this group was 96.5% and the 5 year recurrence rate was 5.2%.The postoperative contour of the breast was satisfactory.ConclusionBreast-conserving surgery is safe and effective therapy for early breast cancer, when strict indication and necessary safe margin of resection is obeyed by. Postoperative radiotherapy and chemotherapy should be properly arranged and the patients should be closely followed-up.

Objective To evaluate the application of the inlay butterfly cartilage graft technique in myringoplasty.Methods Thirty--eight ears in 38 patients (experiment group) with dry central drum perforations were treated with inlay butterfly cartilage myringoplasty,and 46 ears in 46 patients with underlay temporalis fascia myringoplasty (control group).Results After a mean follow-up of 6 months,the healing rate did not differ between two groups (92.1% in experiment group,91.3% in control group,P＞ 0.05).Average pure-tone hearing threshold improved than 10 dB and closure of the air-bone gap (ABG) within 10 dB were not different (P ＞ 0.05).The cured patients were followed up for 12-38 months,there was no ear perforation of drum in experiment group,but 4 ears in control group.Condusion Inlay butterfly cartilage myringoplasty is the reliable and ideal method for tzeating dry central drum pedoration with high success rate.

Purpose To observe the effects of umbilical cataplasm on rat gastrointestinal motility and gastrointestinal hormones using rat model of gastric operation,and to explore its possible mechanism.Methods ①The peristalsis length of carbon ink in small intestine of 20 rats was investigated by the use of umbilical cataplasm,compared with the matrix cataplasm group and the untreated control group. ②By means of radioimmunoassay,the levels of motilin(MOT) and somatostatin(SS) in small intestine tissue of 20 rats were investigated after a ten-day course of application of umbilical cataplasm.Results ①The group of umbilical cataplasm could significantly increase the peristalsis length of carbon ink in the rat small intestine and the distance percentage to the whole intestine,compared with the matrix cataplasm group and the untreated control group has significant difference(P＜0.01),and has no significant differernce between the other two groups(P＞0.05). ②Umbilical cataplasm can increase the levels of MOT and decrease the levels of SS in small intestine tissue of rat,compared with the untreated group P＜0.05 or P<0.01.Conclusion Umbilical cataplasm can promote gastrointestinal peristalsis of the rat model of gastric operation, and can regulate the levels of gastrointestinal hormones.